HomeMy WebLinkAboutPermit Electrical 1997-8-28
The following proje-t ~Ub '
zoning, andri.~at 'I mitted.~;:)a th,:') iO;:O',Ji!1f1
approval. nr~ eqLJ.re SPeclJIC J",nd u: ; -
Zoning r;, 2i/ q1
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. LOCATION OF INSTALLATI/O~ 'Z.J--
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Permits are non-transfelable .and expire
if work is not started ~ithin 180 days
, of issuance or if york is suspended for
180 days.
9ft1] - r M
Ail~6013.: '6& gignature
Expiration Date
OVNER INSTALLATION
The installation is being made on
property I ovn which is not intended
for sale, lease or rent.
Ovners Signature:
D~TE~-----~-~t{,\--~------~-~-~'
RECEIPT t: .,,;,.\ I.,r~~.
RECEIVED BY: 'tJ \}J.J'" .
ELECTRICAL PERMIT APPLICATION
Ci ty Job Number a.l \ \ \. Q\
200 amps. "OT less ,
201 amps to 400 amps
Over 401 to 600 amps
'Over 600 amps or 1000 volts
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
J
$ 40.00
$ 55.00
$ 80.00
see/ liB" above
2. CONTRACTOR INSTALLATION ONLY ,B. Services or Feeders,
Installation, Alterations
Electrical contractor~"~i~ or Relocation:
Address PD. 60i. I ~3~3 200 amps or less
~ ~~01 amps to 400 amps
Ci ty DD ~ yy\ Phone hf)':\-J1RE-1.J8'1Q ft,~O' ,1$1 amps to, 600 amps
-\~ {O~01 amps to 1000 amps
Supervisor License Number :(:;{ ;?,?; --;~~ #' ~er 1000 amps/volts
.J....~"I. ~~~ ~ '<<'fi:econnec t Only
JD -I -qrg , ~I'" ,))~ ~~ .
. ll~~Y ~~' ~~OC. Temporary Services or Feeders
Constr Contr. Number D~i~, ~<() ~<<>~ Installation, Alteration or Relocation
~~~\ .JI. ~ .
Expiration Date ~~~'CJ;.~ ~O<),;o. ",p~'
, ~ -v.-O ~CJ'<; ~~
Signature of superV1~Sin ~~~'t~~
~~ // // IP ,'O~
~~ ~./ ..k'~~~
~- D. Branch Circuits
Owners Name -1 Of ks liL ~ ,tIDYY\.li S, ~
Address \ e>q F>. r6.LihG th.-u~ / p(), !2Jox LJSl
Ci ty y{)"Y'lYY1rJlJ'l-h Phone 5~-<?; ~%-OOCffo
,.
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
E. Miscellaneous (Service/feeder
-Each installation
- Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$ 35.00
$
2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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