HomeMy WebLinkAboutPermit Electrical 2002-8-19
. 225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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ELEaAL PERMIT APPLICATION
City Job Number 0 Z -0 09 '7 '7-0 I
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3. COMPLETE FEE SCHEDULE BELOW
1. LOC~ nON OF INST ALLA nON 1\ .Ie
J hS 7 Dl::--z:.,e.ost: I'l vc: A. New Residential-Single or
Multi~tll&ily per dwelling unit.
A. S IlleWl~ncJuded:
,-,0 I Z. 3. n""I\Oo \'I0\IC \0,,0
s\)V neC'
eC\ as \.\\(0 51'
. o?'O\ l,eCl
\l0"\"~ oeS ,,0 Vb: 10
. Sb/hl'\:~~!~if( 0'2: ach . 0~a1500
.(0 c.((2.~ ~0","9, \ ~ . fl or po
Permi are non-transferable and expire
if work is not started within 180 da)'S Ie l\l,e
of issuance or if work is suspended 'ftj} (l~eO 519,,0
180 days. 1'\1,,'0
LEGAl- DE~CRIPTlON
nUS 2Lf3>4
.(
Items Cost
Sum
$106.00
$ 19.00
Each Manufd 1I0me or
Modular Dwelling
Service or Feeder
$ 50.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
(l ~ (' - T': Installation, Alterations or
Electrical Conlractor~,-"') ElfdJiC)--\...rc. Relocation:
Address ~O. ~K \L\-~]...
ciSorirdklol Phon;lY \ f~2-30
{ j
Supervisor License Number 4gV)L(.S
IDldm
200 amps or less
20 I amps to 400 amps
40 I amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
-.L $ 63.00 b 3,
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Expiration Date
Conslr Contr. Number ~
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
q j II 02..
200 amps or less
20 I amps to 400 amps
Over 40 I to 600 amps
Over 600 amps or 1000 volts see
liB" above
$50.00
$69.00
$100.00
Signature of Supervising Electrician
~ ~QF .JlOQ..
Owners Name 1'\ -Alii '" j OJc=A-LL
D: Branch Circuits
New, Alteration or Extension Per Panel
Address I b <:;7 I:x:-- f r <0 S ~ AI t'
City. sf' fi\ Phone -
OWNER INSTALLATION
One Circuit
$43.00
Each Additional Circuit or with Service 3 0
or Feeder Permit -1!2... $ 3.00 _
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lightinl!
Limited Energy/Res
Limited Energy/Comm
TOTAL
$50.00
$50.00
$25.00
$45.00
crs
b'S(
74'1'
(06 'IS-
Owners Signature:
mO:(j3IHS~8
: 39N~HJ
g6'901 $ G:083(j lW~
GOOG 61 9n~:31~O
G~~0100-10:#SN~(jl
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
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