HomeMy WebLinkAboutPermit Electrical 2001-8-28
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225 FIFTH STREET 84thQ,fized Signature ~i1li-
SPRINGFIELD, OREGON 9741' 6'--
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726.3753
FAX (541) 726.3689
ELECTRICAL PERMIT APPLICATION
City Job Number C)(-oO 8'<;-2 -of
3. COMPLETE FEE SCHEDULE BELOV
1.
LOCATION OF INSTALLATION
t,fSO Ferelv WAy'
LEGAL DESCRIPTION
1802.6 51 Z-
o :s :30 0
JOB DESCRIPTIOp
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Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor EA5r5/D€ c.lcc -:fIJC.
Address ?'t;~S-3 605CAGE 1..",.,(
Ci ty Sf' ';-(,0
Phone 7 <{ (, I'Iq 9
Supervisor License Number Y7;;J.? 5
Expiration Date
}D-{)/-O(
Constr Contr. Number 1/7770
Expiration Date I (rO I-O(
Signature of Supervising Electrician
~9-1 ~
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Owners Name T/r.c,^^~
(.,RD ~ 0'--1
Address f--e:-r~
City
C::::;~FlJ
72b--<6?)S-
Phone
OVNER INSTALLATION
The installation is being made. on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DATE:
RECEIPT 1I:
RECEIVED BY:
c> If 170/
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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 Dwelling
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
Installation,. Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B" above
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit I
Each Additional
Circuit or with Service
or Feeder Permit --+--
E.
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
$~O i{'3
$.z.:-oo>
not included)
$ 40.Qf).
$ 40.00; -l
$ 20.Q(t:D T;:
$ 36.QQi;:;:i~
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