HomeMy WebLinkAboutPermit Electrical 1995-8-4
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72b~3'7"if9d Signatur.-lI~'-
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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,
JOB DESCRIPTI.Q!!. "'7:>.,
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Permits are non-transferable and expire
if work is not started vi thin 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACfOR INSTALLATION ONLY
Electrical Contractor ~/~;"":'~
Address
Ci ty
Phone
Supervisor License Number
Expiration Date
,,~
ELECTRICAL PERMIT APPLICATION
"
Ci ty Job Number tC}'3/2SBa
3. COMPLETE FEE SCHEDULE BELOIl
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home. or
Modular'Dvelling
Service or Feeder
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
Items Cost
Sum
$ 85.00
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Temporary Services or Feeders
Installa~ion, Alteration or Relocation
200 amps' 'or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80:00
Over 600 amps or 1000 volts see "B" above
D. Branch Circuits
.
New, Al tera t ion or Extension Per Panel
Constr Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name #"I>~ ~~Ll.#~
Address ~4jig~;Y /;h9~
Ci ty 4~ ~ Phone 7Y?-727;1
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OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
~~~~m~
---------~---------~~-~- - --------------
DATE: $/~/ 5'...r
RECEIPT fit / 5'".,. 15
RP.r.F.TVRO BY: ~ A..-......
One Circuit
Each Additional
Circuit or vith Servic~
or Feeder Permit ~ $
""""---$ 35.00
~
2.00
8.-
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
not'included)
$
$
$
$
4/3. -:if>
, ::?~
z,i.:37r
40.00
40.00
20.00
36.00