HomeMy WebLinkAboutPermit Electrical 2002-5-31
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. " , E~CAL PERMIT APPLICATION
: I l--' i City Joh Numher D d, IJn @~jj!3l:fm-~BO%31~
, I : I' :' , i7,Yt::MAY .:\1 LOOL
1.3. COMPLETE FEE SCHEDULE BELOW AMT REeD:2 t72.45
, ., I LHANGE:
L - ..: IA. Ne;Y'Residential-Single or' .cASHIER: 001
Multi-Famil)' per dwelling unit.
Service Included:
JOB DESCRIPTION 1000 sq.ft. or less
/2.e) cCA/fe.. S-ef vtce-T.:'~ project as submi~.g\\\liti6lIl;~i~80
1 zoning and does not require Sf}9itfinrlpodti.are
Permits me 'lon-transferable and e:qJipeoval _ /7 thereof
if work is not started within 180 days Zoning _I. f) ~ "...1, """,,P..uIQme or
of issuance or if work is suspended6'1.~e 5..:>, 1-0'2-, Modular Dwelling
180 days. ~Scrvice or Feeder
AuthOrized Signature
'.
...
225 FIITH STREET. \ '
, SPRiNGFIELD, OREGON 97777 :
INSPECTION REQWOST: 726-3769
OFFICE: 726"3759 I '
1. LOCATION OF INSTALLATION
t. .20 Vt-/J-1'YI1IJ6--0'
LEGAL DESCRIPTION
ies'ld~1.fp.J /"'7 ''OS,::) ~I ~ L7000
2. CONTRACTOR INST ALLA TI0N ONLY
E clricai' Contractor
~
/~
j'
Address
.,: ~.. ' ," .~,..,. ',- .,/." ..'.'
.," ,,-,~;,;4:"',~,'_o:eai' the, OregY";~Jt.'Hq
City '. '"!"''"!_'~ tl.w hone.l__....;:.,., :""-,.,.. ~r;.L- \
,., 'IU"< -\'. I 11;O:::>t;I...,...~ -.' ~~
-' t " J"-,L "" '" \ (" ~>>
".,r.Cl',;'..Xlj if1 'Hhrouqtl'OAR952-l'Q -
Supervisor Lie se NUt er. ': _ .1 ~~ ~ .. ,1.......<" b"
,GJU. 'rf)lJ~~JY ;'?latrl~;I'!..:,~,:",,:,,~ ,~7 .:-~--\~}~',
E. .-"",.)" lD,,;j:;"r::iit,jlr,{No."'~~tBlepl:JOnl!1;
xplra n ate '- . .,,~ ...L_~:t~.......;.._""
,,' ItOGr 1urh*, ',JI ~t;'~:: . ._~-,,'l~J,":~-""":::,~,~,. -'"
f.. - ". 'r.::':r~'",:.l.:',-'l. .~rr,'~'" '~~itt4ft.)-.
./ onstr Contr:;Number ,- . <. . .
. Expiration Date
Signature of .Sujlen.jsing Electrician
Owners NameJJevb-er1 T bJ~()/leY
Address (P2o Ft.-/f-MltJ6-0 .
CitySDafJJ3-~IELD Phone 7C/G- t..f9sg
- I
OWNER INSTALLATION
The installation is being made on
property 1 own which is not intended
for sale, lease or rent.
Signature: .
.Jr J, Va;./
Items Cost
Sum
$106.00
$ ]9.00
$ 50.00
B. Scn..ices or Feeders
Installation, Alterations or
Relocation:
200 amps or less l $ 63.00 ~-S cI2
20 I amps to 40.0 amps ~ $ 75.0Q
401 amps to 600 amps '$125..00
I
601 amps to 1000 amps $163.00
O~ooo amps/\'olts ~5.00
Ji ~e~Att: EXPIRE IF T . to.oo =
nlls '~' l'W~f\iH\S PERM ~
TMl~MOWiR:l '~Or~I\'WA~OONEtl FOR >'
I~Q!I\M~Il~r. . i\fibRelocation .
fl.NY 180 Ofl.Y PE , . -
200 amps or less
201 amps to 400 amps
O)'er 401 to 600 amps
O\'er 600 amps or 1000 VOIIS see
"B II aboye.
$50.00
$69.00
$100.00
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit
$43.00
Each Additiona] Circuit or with Service
or Feeder Permit
$ 3.00
E. 'Miscellaneous (Scr\'icelfeedcr not included)
-Each installation
Pump .or irrigation
Sign/Outline Lighting
Limited EuergylRes
Limited EnergylComm
$50.00
$50.00
$25.00
$45.00
~
I\-linim~ml Electric Permit Insjlection Fcc is 545.00 + Surcharges
4. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrati\'e Fcc
t~. t;O
q.Lf!
i; iilf
7)'~S
TOTAL