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HomeMy WebLinkAboutPermit Electrical 1997-9-22 . l~ sr.:nINC.O....\ _ ..~:. .~'...h"~::J.I. ."~I;;",. u:; row rm:i.r.CJ n~G tho fol:owin . 6,,0. ,In'1' :1[1:.1 doe:; not mqulrQ L\p&Cific Innd J ,....:'0 fllJprO\/:I!. . . ... .....'" Z.,0109 Ld--v2...: ELECTRICAL PERMIT APPLICATION 9~;~~:rf6$1)r:)41 City Job Number crt. I 04-4' Authorized Signature f\ N\ ~. CU~PLLi~ r~E SCHEDULE BELOV 225 ,FIITH STREET SPRINGFIELD, OREGON WSPECfION REQlJEST: OFFICE: 726-3759 1: LOCATION OF WSTALLATION " ' _ qbS rAle~~ ",:LI\-c~ LEGAL DESCRIPTION / 7 0 3.1,4Z.Z-0b ~40 JOB DESCRIPTION (.AileE A/€1A/ jllJv'~' n - . '" .. Permits are non-transferable and expi~e if \lork is not started' \Ii thin 180 days 'of issuance or if vork is suspended for '180 days. ' , A. Nev Residential-Single or Hulti-Family per dvelling unit. Service Included: Sum Iti!ms Cost 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion ""> thereof ' ~ $ 15.00 Each Hanufid Home or Hodular D~elling Service or Feeder $ ~O.OO ~!; 4~ 2. CO~~CfOR INSTALLATION ONLY B. Services or Feeders , Installation,' Alterations Electrical ContraCtorj..H. Milu.,{. L..,t~ or Relocation: Address 4-~?:' Sh et/", Srf- 200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 City SPFo. Phone 74'1--0((( 401 amps to 600 amps $100.00 601 amps'to 1000 amps $130.00 . Supervisor License Number ? Ot)b~ S Over 1000 amps/vol ts $300.00 . , I "'" K' NOlte€.: Reconn{fFtr~WORK $ ~o-.OO Expiration Date JO~ -' I ,M"Stl"LLE.;(JI\f\ :T , lt1I"~ C. J'~~I\~IIEv.WSl,~~es or' Feeders Constr Contr. Number...L2/ ~ 3 rt' ~IITHOfi\ZEOI.JNO'lnst~~teTfOf,\lteration or Relocation 'l, E,,\CED OR IS /'.'<3/>. ., ' Expi'ratlon Date (..,,- <;( r'7 9> COMM "ER~ amps or less $ ~O.OO , . ,..' , p.,N'f '11",0"" . 201 amps to .400 amps $ 55.00 Signature of Supervising Electrician .. . Over ~Ol to '600 amps $ 80.00 ~_ Q _Kl o~...,' Over 600 ampS, or 1000,volts..see "B" above ,,= Pvnr1~~ ,/J~lot.o3(N1\IJQi~-5 D.' Branch Circuits , f \ r-'.Jl.i\~ I Nev, Alteration or Extension Per Panel Addre~, U ( ~ R::'N \ ' ' -vrt1 TY71' _ 'O~e Cir~uit $ 35.00 City ..1~L,.', 'P,',ho,ne,' "'""t'\ 'V1, W ,Each Additional , , Circui,Cor vIth Ser,vice, OITNER lSTALLATlON or' 'FeederPe,rmi t $ 2.00 The installatioh, is,being made on property,~ o~n,yhich is not intended for sal,e, 'lease ot' ~en,t. ' ,/Nn,ers S~gM ture: ....,... ..' .. .. :." . DATE: RECeIPT, i: ' RECEIVED BY: .~.A I.h~''')'' " ,~~,,"'."W'~~ 'A- / -- , E. Hiscellaneous (Service/feeder -Each installation Pu~~ or {rrigatioh' Sfgn/Outlihe ,Lighting' Limited Energy/Res Ciciited,Energy/Comm . ..". ...-". '-. not included) 5,. SUBTOTAL OF"ABOVE 5X 'State ,Surcharge ,TOTAL,' ,: ."' ..... :.. .' ,$ 40.00 $ ~O.OO $ ,20.00 $36;00 - ,~() ~ 0~V_ '7, 'f'o J +0 f'O _ + ?::F}h AQffi'\{\ \rl:.;~~