HomeMy WebLinkAboutPermit Electrical 2001-10-24 (2)
The!;' . Ing project es submitted hes the following .
225 rlFrH STREET Zdfil, d does not require specific land uss ELE ICAL PERMIT APPUCATION
SPRINGFIELD. ORE~ 477 r-.IJ
INSPECTION REQUEST: 72'.(!11l1q'" 1/\"""1 """ '~b NUlllber
OrrICE: 726-.1759 Dal" _ 10 .c')l.-1. .0 I I'
I. LOCATIO.!::!. OF Ir.fS'I"xt~~f1@ll&ture ~MPLETE FEE SCIIEDULE BELOIV
z.... ".....2- DI1lY\A <;. ^ New Residential-Single or
Multi-Family per d,,'cIling unit.
LEGAL DESCRIPTION Sm'ice Included:
17 . 03 . 7;3 . Uu. OO,'LO lIems Cosl SUIIl
.1013 DESCRIPTION I
ytC{)ktco . ~.
Permits arc non-transferable :md c.\:pirc
irwork is not started within ISO days
of isslliJllce or if work is suspended for
ISO days.
1000 sq.n. or less
Each addilional 500
sq. n or portion
thereor
Eaeh ManuI'd lIome or
Modnlar Dwelling
Service or Fceder
$106.00
$ 19.00
$ 50.00
2. CONTRACTOR INSTALLATION ONLY
B. Services or Feeders
InSlallation. Alterations or
Relocalion:
Electrical Conlmctor0l~b f::U.:{;;:rC:> iG
Address 2..151 VD ()
Cit)~rl oczf' o'JrY Phone')41-14b-4bS f"
Supervisor Lieense NUlIlber ..q'E) 1'S S
sf .
200 alllps or less
20 I alllps 10 400 alllps
40 I alllps 10 600 alllps
6111 mnps 10 1000 alllps
CIi'er 1000 amps/\'Olts
Recounect Only
_$ 6.l.00 A-
$ 75.110
$125.00
$16.1.00
$.175.011
$ 50.00
bpimlion Date 10- \ - a '+
Constr ConlL NUlIlber :<{.5/2Pb
bpimlion Dale 4 - 2.. '-1-. O'L .. SHALL EXPIRE IF T~6o~2~sKor less
I. ' _' I\ UNDER THIS PERfv:iiW?lI~;p,;1jo 400 :nnps
Signlllure or Supervising Eleclrician 'J OR IS ABAND()NE~'8'f1"lto 6110 alllps
L;l , ~ -' Over 600 amps or 10110 \'olls see
p;.:'i ,;:' o\Y Pf'RIOD. "13" abo\'e
~~~ -
'l'\ D. Bmnch Circuils
Owners Nallle Vh t m A 11'0)(
C. Tempora,)' Ser"ices or reeders
Inslallalion. Allemtion or Relocaliun
$5(1.(1(1
$69.(1(1
$10(1.00
Address2...'S-;:l.,? ()()('Y\{\~
CityS(JI"I,,,r. G.n:iPhone 12.Jo -0140
OWr-'lER ;;st~LLATION
New. Allcralioll or Extension Per Panel
One Circuit
$4.1.(1(1
Ench Additional Circuit or with Service
or Feeder Permit
$ .1.0(1
The installation is being mllde on
propcr1y I own which is not intended
for sale. lease or renl.
E. Miseellancous (Sen'ice/reeder not included)
-Each inslallalion
Pul11por irrigation
Sign/Outline Lighling_
Limited Energy/Res
. Limiled Energy/Conlin
$5(1.(10
$5(1.(1(1
$25.(1(1
$45.00
Owners Signature:
'.
3\:0: iJ3IHS\78
: 39N\7H8
S9'3L $ 3:083iJ 1W\7
1003 30 .l80: 31 \70
9889000-10:#SN\7iJ1
10-.....1.
..
5. SUBTOTAL OF ABOVE
71X. Stale Surcharge
WX. AClil1i'ni;lrativc Fcc
.. .).
TOfI\L
Io~ -
<lAl
<; .0"1
c
72.....4 S"