HomeMy WebLinkAboutPermit Electrical 2002-3-21
225 FIFTII STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
.
ELECTRlI. PElUvlIT APPLICATION
City Job Number 0 Z - 00 111-0 I
3. COMPLETE FEE SCHEDULE BELOW
1. LOCATION OF INSTALLATION
. .'btfl)q FdiC' QVI D (. Sp ri r\;{iCld A. New Residential-Single or . '.
.' Multi-Family per dwelling unit
LEGAL DESCRJPTION The '0I19'Y~ . , Service Included: '~
170Z i94], ~onl~'{~W^'f!J>c'asSUbmllted '. . Items Cost Sum
- -"'''''uvaJ ~ rsquire s ~~s the 101/0w'
peclf,C la 109 I' /'i 00
JOB DESCRJPTION ZOning Co rZ. 11\'8o"~.ft. orless _ S106.00 /(/tP.
wl1rrte.. !/louse D~i.dV1 =:::.;> _ Each additional 500
AU/Oaf/Zed" ',;},-O sq. nUl pOrtion 1/ 7/ 0
Pennitsarenon-transferableande~atur€ 2 S19.00 ~,O
if work is not started within 180' days ch Manufd Home or
of issuance or if work is suspended for Modular welling
180 days. Service or Feeder S 50.00
2. CONTRACTOR INSTALLATION ONLY B. ServicesorF~~~'t"" i?q~iresyouto
r . f\T.lFNiWbl1G;;'~rtbit1fihtn6\lon Utility
Electrical Contractor G 4 E 1= Ie (. 1"\" I c.. '1'ofto\7{rullSeldtill~d by rules are set forth
P Q [().f~ Notiflcatloncenter.ThOse hOAR952-001-
Address 0 UOX 0u'V inOAR9salOOh~1-Q~~g oftheru1es.ID'.-S63.00_
q r.i1.Q99'~O~3lJlfi\lllOII!b6IetelePhonll......- S 75.00_
CitLllJ bel ~1 V Phone 5L/r 07- if(tl6a1I'inlf~tft/'$6 n~~Notlllcat~ SI25.00_
J(}(J'()S numbe~~nt/lIjl~tVlfil6 .'2344). _SI63.00_
Supervisor License Number ,'X '1 rJ, ~uml6 ~ _ $375.00 _
10/ I (2003 Reconnect Only $ 50.00
, .,
Constr-Contr:.Nwnber J I.f '-I f?, R
q 1/5 /2-003
Expiration pate
C. Temporary Services or Feeders
Installation, Alteration or Relocation
':1:
Expiration Date
200 amps or less $50.00
NO~QM!nPS to 400 amps _ $69.00 _
Signature of Supervising Electrician bVtr'lfol ~~~dR~ IFTHEWOBKSIOO.OO _
...[ -E? j(\ (\ n ~ -:=~~UNDERTHISP~A'WiITISNOT
^ s;;: c '~\ C r.nMMFNCEDOR IS ABANDONED FOR
Ie" ') t 1...) -" ,L. D. Btlll\cliCiicu\!j
OwnerrNaiile ....r) AN'N~~~la~~P2'hension Per Panel
~ vl:>fL .[ A-t.Ltry t::!.lciR. ~
Address P:J:'!. ~ ;.:' 3. '3 t't ,I One Circuit
City~A-l~Phone 726 -0330 Each Additional Circuit or with Service
OWNER INSTALLATION or Feeder Permit
S43.00
S 3.00
Owners Signature:
E. Miscellaneous (Service/feeder not included)
. -Each installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergylRes
Limited Energy/Comm
S50.00
S50.00
S25.00
S45.00
The installation is being made on
property I own which is not intended
for sale, lease or rent.
190:~jlH::;\J~
: 39N\JH:J
O~'60G $ G:Q:J3~ lW\J
GOOG lZ ~\JW:31\JQ
GL~8000-10:#SN\J~1
Minimum Elect..;c Permit Inspection Fec is $45.00 + Surcharges
TOTAL
I f)z,()()
_'.:J,.7l.{.
1<./ ,5(('
(J,oq, 30
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee