HomeMy WebLinkAboutPermit Electrical 1998-12-8
SPRINGFIELD ",.
The loilov,ing project BlI oubmlllecI .. tile to1IGlilnI
zor.ing. and does noInlqU1nl speclIlo lend \ISO
approval,
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
Zoninp l.D ~
9;i~h'lt9 I:J -4 '",-
Authortzed 8lgnaIure -Kv->
ELECTRICAL PERMIT APPLICATION
City Job Number ~-/J.9g,9
~VM~Lhlh rhi SCHEDULE BELO~
j.
1. LOCATION OF INSTALLATION
/:;..2J /28. "!,("{;.. . A, New Residential-Single or
~YM D,E~Cl)J)Il'J{I<M:I /DO NOrICE: S\-I{>.LL ~~~M~rn~ru~~,: dwelling
b / U5 .1-:> '-rl-f Ub 1'11S PER\~',\I - \-lIS PERMI, IS N \ Items
'ORF'D UNDER I to fOR
JOB DESCRIPTION NJlh '.", OR \S~000~1S<;(~fP. or less
--JlEIi/ S/ll.IttE ;r::;tm1t V ~EJE~"C ,0 ' :. ~Hch addi tional 500
,,' ;c;, ',i':1 prrll' 'sq, ft or portion
I "l I'"~ .
Permits are non-transferable and"expire thereof
if work is not started within 180 days Each Manuf'd Home. or
of issuance or if work is suspended for Modular Dwelling
180 days. . Service or Feeder
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor 5/ft/e:. (),It/ ~t/:ct'";
Address .tXJ;- ,;z,s15~
City 6tt~~ Phone 3'1'1 o/'/zr
Supervisor License Number .,~&f3..s
Expiration Date
/1)-/-0/
Constr Contr, Number_ ,C;-6,6 9''/
Expiration Date
5'-I/'- 9''1
Si,""'~~~ ",o,eio'"
Owners ~t( I SI!r/If6E~,ItQ;
Address 27f~~ &~ d.
Ci ty E-tlU,f/L Phone ~Y7-()5(7'y
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale. lease or rent.
Owners Signature:
~~~~:~-~;t~~~-~-~----------~
RECEIVED BY: ~ r I b1 _
L $
~'$
uni t.
Cost Sum
85,00 35 ,(Jl)
15.00 ~
.$ 40,00
Services or Feeders
Installation, Alterations
or Relocation:
ATTENilON'
200 i!-.nf\3!lo\QfUi!,~,&oregon laIN '{Jq S 50.00
201 'illf/(i6c<!lfurP (J '$il(J:kl bVthg 0 tgr~~o
4011!irlif>tR~2? 8n!flnpsho~o r . r~<OOt"i)j)ty
601 ~ YOB T OO@rt(jlif/ !I.es @1Iel~elrt
Over ~f1h\ I$lfQb!<li,fj ,,~O/ffU)~2. /'
Reconollib~~9,!\l~enter, (N~Of l&e4-9113 -
or t e Oregon '" e telephone y
TempOrarY~li'twi..~~~&f lfJ~i@d~f; at'
Installation, Alterat~~2B44r.elob~ion
B.
C.
200 amps' 'OT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see llB" above
.'
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
S 2.00
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
S 40.00
S 40.00
S 20.00
S 36.00
-':~'
&).00
: ~--'r6.V
" '_ ,VO
. . T
-. . /LfO .110
-.,... -