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HomeMy WebLinkAboutPermit Electrical 2002-8-21 (2) / -225 FIFTH STREET ::-: --\ f"'1 (:" .---', n ,., E,LE.CAVPERMIT ApPLICATION , - "SPRINGFIELD', OREGON97477 I '_J f: .,. II \ '~! INSP~F;CTIO},l REQUf~t726j7,69 :fjt-1 Ii, :Cit,Y Joh Number 02.- 0 1011 - 0 I '~. .i t~~F\CE 72?-F59' 'j t . ~_i!' _! !i ,:'U 11 t' I, :. . . ~":: >nIL: '0:\ i[i (" ::r__).-COMPLETEFEESCHEDULEBELOW \ .) I .1. LOCt\TI(?NQ.FIN~TALIATIPN r. ,.!;' ii' j ! ". . '-.-' -'.3 'C{q f<( "-r'/fztk.LYt';";r (3!:-l/~--~ A~-Ne'YResidenti!II-Single or-'~' .... - --;rr'l <;l,t9Jft'N6-{IEC!:> Multi-Family per d\\"ellingunil. \' LEGAL DESCRIPTION Sen'ice Included: /7033, '-NZ (')Z'-{OO Items Cost Sum'.' JOB DESCRIPTION ~ /. W@ sq.ft. or less (] j, /1-1..) A-F t9 V I /I1~#/~ I1t/MF\o"~:ch additional 500 - . .\1"'0J>" ,,0&1 1 e L ,~.o ~l>(\O Il><' sq. ft or portion /-,/7 r-r. ~((\ eC\ PermIts arc ~lon-transferable and expire \essu ~~e 509 tl1 if work is notlstarted within 180.~t}'(l!ci\.o(\01 ,.0." /. V ,ae!, nufd Home or / of issuance or'ifwork is s~'/J~A5f' V ,O-v. odular welling I I. ~~ ~ '" ~. 180 days. .' 1.0(\'(\ '..1. ,. eorFeeder . ,), a.'9'9~o-.j 1.o(\\(\~ ; ! 2. CONTRACTOR INSTALLATIO Y . . SelTiees or Feeders . ". \V' / i .. ~ \0 tfII9{\'a Installation, Alterations or \ ElectricaIC~ntt~cto~~GZ',!j~O ::::'f~~G/JE Relocation: /..., ~. '\ Address #00l3o.' 81& FA.LL ('~"t6? 200ampsorles/ . y.~~~\l:f63.0~'~ ..,.,.-;\' ,( , {Y-,/. '.' '/\ ',,- 201 amps to 100 amps x.\'('\ ,,~1~75.00_. " Cityl-AtL (?~PAi(P.hone 757o/b?5"u ". 401 ampst~600a~\VI~'(.,?-~\~$125.00_ l,'."; I 1\ ,,/ m '. 6JH~.aI'%,~t~n~\'Of'\f\~'(.~_$163.00_ Supemsbr Licens,e'Number -::z.:2,q 02S '. "",~"\~d.~~' S :Qt-~\i\J . $375.00_ I ,I '. :J 'I ' III' ." \' ~'b~~~ '~\~ ~ =+$ 50.00.5:9 r. Expiration Date I /D / 6 I r '* " ,,\~\,\\\\)~,,,\;'(.~ . ,i.~\\)~' f . ., {/' " " ~ ' 'I '4, ,: ',61'\ '-' ' C. Tclhp,l!~~~l(>;~~dl' Feeders '. I ConstrJ;:~tr. Number' I:)}!( ifl,. T '. Ins~~'l~Il1,nltion or Relocation ~..', ~'c;C?E;:?iration ;;;;~-5y I.t.'k,'lt>, ,';..; '.~;;~~ "~llPS or less,' . , . ~ ~~0.00 _ . ,:'" ...---~ 201 ampst0400amps $69.00 Sign';t~'i'c of Supervising Electrician -, ~--_Over 401 to 600 amps. '$100.00 ' '....... "~'_"." . . ~~ . .. '.d1", ", ~ Over 600'amps.or1.0~.0 volts see . .' ..,', ,"-. " "B" above ~---_.. .' ;:I~;~~c"fr;p~l J D. B..a~~~5~~~~~;~Ont6{'E*~~;Jo~~p.~~tncl '. " .. "(){\'''''' 'Ta9u"~'\\tI . . , ".", -- \U 01 I J\>.\..t)~..-\""ltneP. ese\(O' . ,Address "? 9.r7 0' H2.-a..,.,- 1:111 vei' \es<;J.ieWircuibseTl;ileSa~952-O()'\~ $43.00_ . '.IO'IN T~I ~an\eT.ln. ollqnO~. TUIGS'O'I , City KlAG-t-tVC Phone 7Z{, ~7Z7{!.0,'\\'\cat\OTl EachrAllditi~~a!,Gircu. it'6J.I'\'-itl()1 Se,rvice ' ' " " 52 \JV" . rP.u'V' lellil" , ' Op-r'- 9 -or Fet:.c!.etJPenilite. tne\e "'catIOn $ 3.00 ~ . '.n Q '(OU l'(Ia~ taT- ~~O\ . 'l'\~to\ot\,\ . ()Q9&\I',l\'Il;~~R~!!!'(S.c~~~~.ej~iln'ot included) IllTlPel \QEae!J.ins)aIlation .', \ f\ '(Piil~:or:{rrigation . Sign/Outline Lighting Limited Eueq,'ylRes Limited Energy/Comm 190 ~ ~3IHS\K.J OO.~ $:39N\-iH::J O~'09 $ l:aQ~ lw~ 6006 16 9n\-i:31~G' ~~~0100-10':USN~81 ~. .-'~' . h. . ,. '. ;~- ;.~,"" J.,.~ ." , t. j,," ~ ~.." , i . t, " ,. 1"<' .' " , ,. r f. \ ~ $106.00 $ 19.00 , " $ 50.00 .' , OWNER INSTALLATION The installation is' being made on ..' pro"perty I O\vn which is not intended for sale, lease or rent. $50.00 $50.00 $25.00 $45.00 Ownci:s Signature: . . ,,~~~. l\linimum Electric Permit Inspection Fcc is S45.00 + Surcharges 4. SUBTOTAL OF ABOVE 70/0 State Surcharge S% Administrative Fcc ')0 350 YOO 57~ TOTAL . '_0