HomeMy WebLinkAboutPermit Electrical 1999-1-19
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE W '
225 FIFTH STREET AUTHORIZED UNDER THIS PER . 9ti1fCTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97lv7i!JMW::N ... ~ MIT IS NOT 120 ? r
INSPECTION REQUEST: 726-3769 CEOORISAl~~~NEOFORCity Job Number '(1) 1)0.:;)
OFFICE: 726-3759 ANY 180 I1AYtFf\,)D '>. ~ ~ .
'% 0:3'!, \COHPLETE FEE SCHEDUlJ:: BELOY
1. LOCATION OF INSTALLATION "?i \ ~ ~~
/:1. 4/"5 IJf2- ("('Dff!' I2/l ~ % A. '6. lev Residential-Single or
'Ii; '" "'.,?J..l ti-Family per dwelling uni t.
LEGAL DESCRIPTION \ ~.;~vice Included: '
I7tJ'32.'l, 'tV b'tfOD <<. \ ~~ Items Cost Sum
'1', -:;. ~ ~ ~ .
JOB DESCRIPTION 'y l~t sq. ft. or less $ 85.00
/""4~L ~I"( $r~~ > Ea~t.additional 500
sq~At or portion
Permits are non-transferable and expire th~~f $ 15.00
if york is not started within 1BO,days achar~uf/d Home, or
of issuance or if york is suspended for odul.<k 'Dvelling
180 days. eriric~ or Feeder ,$ 40.00
2. CONTRACTOR INSTALLATION ONLY .B.
Electrical Contractor ITa,,..., ~"""'! fr~.
Address /t; g"O Loll fto4r HcJ l ,
~dV' ,
Ci ty~ ~hone _ ~.2.. '7 0(; ~
Supervisor License Number :rtE'O c. \-
Services or Feeders
Installation, Alterations
or Relocation:
Expiration Date
1';/0 t!)
200 amps or less
201 amps to 400 amp;;
401 amps to. 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
;z,igna e o~ising Electrician
/~;r ~
~ ~ D. Branch Circuits
ners Na:rorr~l'/#J (,~~
r New, Alteration or Extension Per Panel
Address / 2 '/~ #4'2 Lc71'C" ~I'l.
~ c One Circui t
Ci ty ez....t:)/Jw Phone >'1S", S IT 20 Each Addi tional
/ Circuit or vith Service
OVNER INSTALLATION ATTENTION:Oregon law r@fluPl!edl!\lt'Permi t
follow rules adopted by the Oregon Utility
The installation is being l1Iadlic3liion Center. TBosel!ldIseE!il:iIl~b:util (Service/feeder not included)
property I own whiCh is nOitl~A~d01-0010througta'CI\Riffi2;1lIlilation
for sale, lease or rent. 0090, You may obtain copJ9lm1ttbe rwil?Eitgation
calling the center. (Note$mw~1ll'! Ligh ting
number for the Oregon u\i~l'f:itll!l!lfidIDlM'gy IRes
Center is 1-800-3~'l!M~i! Energy/Comm
Constr Contr. Number /0"'" I
Expiration Date 60 ,/7t!) /0 c)
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Owners Signature:
-----------------/f--------------------
DATE:_ Ikr fCj
RECEIPT 11: . 32-% Jf- (l ,
RECEIVED BY: ,...r wl)o</,f/
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40.00
$ 55.00
$ BO.OO
see "B" above
.'
$ 35.00
$
2.00
/
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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