HomeMy WebLinkAboutPermit Electrical 1991-2-26 (2)
225 r~r.n ~.AL6.
'SPRINGFIELD, OREGON 97417
"INSPECTION REQUEST: ,726-3769
OFFICE: ' '726-3759
1. U)~O,NO~STALLATION C\,
~ \ \ _" n XY\ 0...1(\(7.:.
LEGAL DESCRIPTION
"llt~~ON "
permit~re non-transf~rable 'and ~xpire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY B.
Electrical Contr,actor1l00m)}~ ,
Address.!E....f)(\~ -D.liL! ~('.J1 &9-,
Ci ty C\. c; r(\ Ve~ Ph~Qe q4~ -S If,J 72-
. Supervisor License Number c!)f}()R S
Services or Feeders (10,Branch'Circuits
included). Installation, Alterations
or Relocation:
100 amps or less
101 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnec t Only .
$ 35.00"
$ 60.00
$ 90.00
$130.00
$300.00
$ 35.00
Expiration Date /O.q /
Constr Co~tr. Number 3 81<.2) 11
Expiration Date A If) / q
'I 1
Sign,~, e'of superviSing,Electrician
\. ~.....~ ~. \\ \\SJ ~1' ~ .
. '.' - . .t.(Q....h0......~_.d_ 0... .J.l_l!.. Branch Circuits
. Owners Nam~l..\'l ~llmr\1~l M.LlQ.(~ '
.,.." 'I'\/Iq~ r\r1," fL"l;~' New, Alteration o'I"Extension Per Panel
Address,..:....JVj ., \ .10 .J.L. I " ' ,
"'.' e:;:'-' ':,', ....1(""/, 317'//'\ OneCircuit. $35.00
C~ty . (~P~l1 n; Phone ~'- )-'- _ V, ,Two ,to ten Circuits .' $ 50.00
, ' " Each Addt'l ten or
,OIlNER IN ALLATION' portion thereof $ '15.00
The 'installation is being, made on
property I own which is ,not,intended
, for sale, lease or rent.
OWners Signature:
DATE:
. RECEIPT ,:
RECEIVED BY:
a?(~L(o'y (
~~~
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less $ 35.00
201 amps to 400 amps, $ 40.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
E~ Miscellaneous (Service/feeder not included)'
-Each 'installation
Pump or irrigation.-
Sign/Outline Lightin~
, Signal, Circui t or
limited,energy, panel'
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$36.00
$ 36.00
$ 36.00
1m ,a:;
'7 .01.../
I ()~ (I()