HomeMy WebLinkAboutPermit Electrical 8-2-23
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225 FIFTH STREET Authorized stgnatlJ@r,a.fV\ _ '9\p.E \r itVfu~~AL PERMIT APPLICATION
SPRINGFIELD, OREGON 9747 7 ~V \ \ Sf\p.,\..\. ~), tJ.\i \S ~ I? q' ( / -
INSPECTION REQUEST: 726-376\\-\\S PE.~~\\ DE.~\\-\\S PE.Rei ~~ob Number 1./1 oO:} lj!J
OFFICE: 726-3759 \1.E.O \j~ NDO~E.O
p.,\j\f\O?l E.O O~\S p.,~NPLETE FEE SCHEDULE BELOV
. 1. LOCATION C{cF INSTALLA7.'ION O,,^,,^E.~C ,00.
Sq(O~ ('5111 St C {~~()\)"'{?~ New Residential-Single or
, p1.f Mul t i-Family per dwelling uni t.
. }..E709)~~JT:fN2oD U 2-iJ Service Included: Items Cost Sum
JOB DES. CRIPTIqtj 1000 sq. ft. or less $ 85.00
r~CJ() \'9Er.f -H- V AC U('\I--K. Each addi tional 500
sq. ft or portion
Permits are non-transferable and expire thereof $ 15.00
if work is not started within 180 days Each Manuf'd Home. or
of issuance or if work is suspended for Modular Dwelling
180 days. Service or Feeder $ 40.00
Electrical ;Contractor~
Address IQ5Mad,'sr:r1
Ci ty E~~n..e Phone
Supervisor License Number
4~CH Z'L.
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B. Services or Feeders
. Installation, Alterations
Elerlt"rc Inoe. Reloca t ion:
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
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
2.
CONTRACTOR INSTALLATION ONLY
Expiration Date 10" -q~
Constr Contr. Number20--12()
Expiration DatejD" J ~9 f)
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
Signature of Supervisin Electrician
. ~1fd ~ '
I
Owners Name 'Dl'CJ<:. :::::a bf n
G ~t
147 "3 l-3S
200 ampg'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; Alteration or Extension Per Panel
Address ~q (n ~
Ci tySpr; ~ ~\~I.d.Phon~
OVNER INSTALLATION
'One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
3S.0()
2.00
$
2.00
Owners Signature:
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
The installation is being made on
property I own which is not intended
for sale, 'lease or ren t.
;~TE~-----~j~-~)f~-~--------------~
RECEIPT #: ?JL S(<KS r<" .
RECEIVED BY: ~ . PIA ~ A
5. SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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