HomeMy WebLinkAboutPermit Electrical 2000-12-18 (2)
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DEVELOPMENT SERVICES DE/iAm~f1ll projectss submitted has the tol/owi
zomng, and does not require specific land use
00 r- g0"3ning oZD~
225 FIFTH STREET Date Id- - I~ - oi)
SPRINGFIELD, OREGON 974Huttoonzed Signature ~vJ
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
, 68
Jli$ T,li~fl€i1S 71if 10000
SPie~GIifilli) l2i $74U'. 70
(?41) 72{)FlAfilEE:
FAX (04rnSflle~~59
B::~CAL PERMIT APPLICATION
City Job Number ()o- 0 , 50J~O(
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dvelling
'Service. or Feeder
-.,....
-.) " "u'
2. CONTRACTOR INSTALLATION ONLY B. Servk~s' ot<-.Fee'd'ers
-.._\. u.. '.'"."
.'" _ ,_(),~ Instellati'on,1,Al.terati9ns'
Electrical Contractor;: ;\-")J--I \-L'T.JS:...JJ-.)Tlt.or Re~,8::ati.9n,,:., ""-""" '" 'c.
J / -ih 4=l:::' 0,. "
Address"'f (J/o,') / J '). II _' I ~ 200 amps 0; less, $ 50.00
.,- " . ,201 amps to 400 amps - '$ 60.00
CitYl:::,UaE'.nc?, Phon~?,t:)7---rD 401 amps to 600 amps $100.00
, 170 '3 601 amps to 1000 amps $130.00
Supervis License Number" J 61-,9 L Over 1000 amps/volts $300.00
, ' Reconnec t Only $ 40.00
Expiration Date i() / I 101
- . ,
Constr Contr. Number ,?,-}f=)5(7-C:
Expiration Date ID/t J f1j
, ,
Signature o,~ectrician_
Ovners N~ i0'S1 ,JfJunIJll
Address! q5 QI) t;JJ?/'r/1,JO/i./l?*-3t
City, ~/~L;ld Phone~;),I()-5Inl()f
OVNER INSTALLATION
1. LOCATION OF INSTALLATION #' d
,~5~()~A~;i 30
~GAL DESCRIPTION
I+O:-,/541'J ()"310a
JOB DESCRIPTION
ISlUl)-""7 lSlu.) J-\.\/A('>
Permits are non-transferable and expire
if york is not started vithin 180 days
of issuance or if york is suspended for
180 days.
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Owners Signature:
---------------------------------------
DATE: I)...' C"('.OO
RECEIPT II: ;,n6<:<'
RECEIVED BY: 1.-1.';
3. COMPLETE FEE SCHEDULE BELOII
A. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
Sum
$ 85.00
$ 15.00
$ 40.00
C.
T~mporary Services or Feeders
,InStallation, Alteration or Relocation
'-- r-"c.P
.". .AJiI"t"S411,
200':.~'l'P~ oplle..~;;":>ID.... $ 40.00
2o.1\.~~psU.to)t:4.99 ampsc-.rv.... $ 55.00
p,,:e! '401.1,t?" ~OO'1amp's....'" vVOr.$: 80.00
Over: 600, ampsSorJr1000'.voTts..see "B" above
. .::"?IOD .. ~lJNEDF=, -"Vi
Branch Circuits OR
D.
Nev, Alteration or Extension Per Panel
~
$ 35.00
~5~
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
2.00
d~
$
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
5. SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
~7. tJ, ,1)
~~
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$.. ,(,J/). 7tJ