HomeMy WebLinkAboutPermit Electrical 2002-8-23
1. LOCATION OF INSTALLATJQN
~ ( 2 lILt . '>-- t tIb...i~"lwW"7
~
ELEL_,.uCAL PERMIT APPLICATION
City Job Numher (:; 'Z -00 623. .-0 \
j
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
CONWLETEFEESCHEDULEBELO\V
LEGAL DESCRIPTION
I 703. z -:> L{3,
/2 (0 \)
A: New Residential-Single or
Multi-Family per dweIIing unit.
Senice Included:
Items Cost
Sunl
JQB D.ESCRIfTION (' 1 .~ 1000 sq.ft. or less
~Vo / V (Lc. 0J Tr.~ct as submitted ~~1Wl\i:t~~~1 500
I zoning, and does not require spe!SidJefl!aod I9~lOn
Permits are non-transferable anspp<piAai Lf\;1.- thereof
if work is not started within 180 days Zon5'9 l) l'i":1~ ~1:~ome or
of issuance or if work is suspen~ed for '3' t'7'" 0 'Z-jMOdUlar Dwel1~ng
uBte S' F d
180 days. ot\l ervlce or ee er
^, . ""d ILb( ::'lgnatLlr~
$106.00
$ 19.00
$ 50.00
ConstrContr. Number
B. Sen'iccs or Feedcrs
Installation, Alten tico'f
Relocation:
2. CONTRACTOR INSTALLATION ONLY
Electrical' Contractor () ( d f,d J S" IN L
Address [4 fD~ w 7 t!::::
City ~, ~ Phone
. 1
Supervisor License Number
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Expiration Date
Expiration Date
Signaturc of SUJlcnising Electrician
~e~:J;: ~ tl, D.. Jl'a~;~vcli~~~~;:on o,tw~~~~,"el
. I i:.~,?\~ l~~\\ ~
Address~2- 4t!bvrr)H-I!CI()(flW W~on~{\~t ,,\'(..fj~ ~'t.'iJ ~~ $43.00
, . .. J ~\\C"'~~\\ '~f~ t>..~\)\j
City~&I' '".jtJ<tJ11/.dPhone ~ \\\~ '?'X:.~~~\SA( i$~'Circuit or with Service
"'\ ~\\aW15~~~ ~@r $ 3.00
OWNER INSTALLATION ~\) ~'t.~ ~ '?~
The installation is being made on 1j)~\\SS~I~neous (Servicc/fceder not included)
property I mVll which is not intended ~~~ -Each installation
for sale, lease or rent. . Pump or irrigation $50.00
Sign/Outline Lighting ~O,OO
Owners Signaturc: Limited EnergylRes v"':'I>25.00
Limited Energy/Comm $45.00
Minimum Elcctric Permit Inspcction Fcc is S45.00 + Surcharges
4. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrativc Fee
TOTAL
cis-ifj)