HomeMy WebLinkAboutPermit Electrical 2002-1-9
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELEL__JCAL PERMIT APPLICATION
City Job Number (:) 1"'-0 0 5'7 Z -0 f
3. CONWLETEFEESCHEDULEBELO\V
1. LOCATION OF INSTALLATION
'L... -, ~ - 5"," I ~f. .<< p
A. New Residential-Single or
Multi-Family per dwelling unit.
Sen'ice Included:
LEGAL DESCRIPTION
'70 Z ?" b 3, 0
0/700
Items Cost Sm:n
JOB DESCRWTION 1000 sq.ft. or less
S t4 c ~ t?v."", If L n ....... "'" e Ea.ch additional 500
I, roject as submitted has the f~\I~~If}!tl or portion
Permits are non-transf~l,qU~.fri~g~Jat:rltlot require specific Ian Ut~lereof
zon'''''tr an
if work is not started '~~88.0 days J...D~ Each_Manui'd Home or
of issuance or if work is suspe~rfgr Modular Dwelling
180 days. l-~ - 0"2...... '\ ~e or Feeder
Date - q<(~
2. CONTRACTOR I~~km~~fu, y . B. Sel-vices or Feeders
Installation, Alterationsor
Relocation:
$106.00
$ 19.00
$ 50.00
Electrical' Contractor'LI".!"'-7 flf~-c/ lit (
kh l-t.L~~;?iC~ Cf\
Phone 7 3 7i~ . ~~
~,,"
Expiration Date
Q." 'L>
X $ 63.00
..$ 75.00
$125.00
$163.00
$375.00
$ .50.00
6)
Address 2f. 'k/ (, .~
Cityr~lIC~
Supervisor License Number
Expiration Date/() - / D - :;lOO:1
Constr Contr. Nmnber_tf 6 )4-,7
S;g.a'ue. of SUP::? Elec'~
/... -
wners Na::'1\.it, d
City
sfJrr)
u/rk
SASkb;-f-
Phone 7Cf( -- h g3!
~E ~
D. Bra~~~%~~~~PJ~?l~\t\$~O"
\\-\\S\?f.~ .... .~OER1\-\\ ....QEOR
on~\'Z.EOU R \5 p..6p..~OO~e$43 .00
ItJ\E~CEOO
EacOO~ditiWWp..CQ'i~~~'Q,ith Service
or F~ ~HMt ~ ~ .' $ 3.00
'1
Address 779)
OWNER INSTALLATION
The installation is being made on
property I o'\.vn which is not intended
for sale, lease or rent.
Owners Signature:
r
1lJ
1
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$50.00
$50.00
$25.00
$45.00
Minimum Electric Permit Inspection Fee is S45.00 + Surcharges
TOTAL
7Z
5cJ'-!
>/(,.
'7 90
'2S' v --
4. SpBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee