HomeMy WebLinkAboutPermit Electrical 2001-11-16 (2)
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
I. LOCATION OF INSTALLATION
4020 Douglas Dr.
LEGAL DESCRIPTIQ~.ArV'\
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JOB DESCRIPTION
Heat pump with handler
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
I 80 days.
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2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor JB ELECTRIC. INC.
Address 4685 Isabelle Street
City Euaene. OR 97402 Phone 541.687.5770
Supervisor License Number 3872S
Expiration Date 10/1/04
Constr Contr. Number 37587C
Expiration Date
10/1/02
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ELECTR~AL PERMI.L1CATION
City10b Number ~ / -0/2 S'i -0 (
3. COMPLETE FEE SCHEDULE BELOW
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
I terns Cost
1000 sq. flu or less
Each additional 500
sq. ft or portion
thereof
Each Manufd Home or
Modular Dwelling
Service or Feeder
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps or less
20 I amps to 400 amps
40 I amps to 600 amps
60 I amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
CCB C. Temporary Services or Feeders
104929
3/14/04
Owners
Will & Christy Ulch
Address 4020 Dougla~ Dr
City Serinafield. OR 97478 Phone 746.9714
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~OO: ~I3IHStJ:J
: 39N~H::J
06'G9 $ G:Q:J3~ lWtJ
1O0l 91 ()DN: 31 tJU
09lI.GJJ{)JQ~ #j!cCilrt15165
200 amps or less
20 I amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts see
B above
D. Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
Eaclt Additional Circuit or with Service
or Feeder Permit
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting_
Limited EnergylRes
Limited Energy/Comm
5. SUBTOTAL OF ABOVE MINIMUM
7% State Surcharge
8% Administrative Fee
TOTAL
Sum
$106.00 $
$19.00 $
$50.00 $
$63.00 $
$75.00 $
$125.00 $
$163.00 $
$375.00 $
$50.00 $
$50.00 $
$69.00 $
$100.00 $
$
$43.00 $ 43.00
$3.00 $ 3.00
$50.00 $
$50.00 $
$25.00 $
$45.00 $
$45,(]() $
$
$
46.00
3.22
3.68
$
52.90
.
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TRANS#:01-0007260
DATE:NOV 15 2001
AMT RECD:2 $ 52,90
CHANGE:
CASHIER: 003
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