HomeMy WebLinkAboutPermit Electrical 1995-8-28
r!-A fJ
~,
Ths followin';J project as ~:J.brnitt~'d.h.;o~ !EI.ECikICAL P'ERMIT APPLICATION
7477 zoning, f.lndfY)ef!5~~llllf: !>pf:!(':IIIC IC..rlU li80
9 ooproval. ~S
726-376'9 g----z15 '-I Ci ty Job Number e9~ //~
Zoning._-fJ-PI" . -
Derte 3. COMPLETE FEE SCHEDULE BELOV
1. LOCATION OF INSJALLATION. . (". _.
1~4//S 2s:?r ~7 /~~ }:!l7?O'j~,~r6-A-: i~ev 1\e~'-loe-rrnal-Single or
. - I' . Multi-Family per dvelling uni t.
LEGAL DESCRIPTION Service Included:
/M~-27'-2~ ~/y,?Jt./
,/
JOB DESCRIPT.ION . d /2
M~~ q-T/~~
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
Expiration Date
Constr Contr. Number
Expiration Date
'\heinstall~tionis being made on
rop~rty I ~~n ~hich is not intended
I
or sale, lease or rent.
rners Signa ture:
l______________________~______________
--R ~ 2..:lf. ~ s--
/~YL/ .
. .,y~--~
TE:
CEIPT #:
I
CEIVED .BY:
Items
Cost
Sum
~ $ 85.00 I~
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 15.00
$ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Temporar~ Services or reeders
Inst~llation, Alter~tirin or Relocation
'200 amps 'or' 'less
.201 ampi to 400 amps
Over ~Olto 600 amps
Over 600 amps or 1000v6lts
z
40.00 ~ ~
55.00
80.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
'~ A 1, Installation, Alterations or
Electrical Contractor~~~ ~~L.Relocation:
Address 407 'Ai w 7'81}11 ~6E3t 200 amps or less
\ -. 201 amps to 400 amps
Ci ty l/4'nIt uJf) . Phone~)'f?7l{i'~ 401 amps to 600 amps
601 amps to 1000 amps
Supervisor License Number ~~LJ~ ~ Over 1000 amps/volts
/ / Reconnec t Only
/0 / ~~ '
.. I C.
I~J -~<..4C!J
.,.".... - --
rDJ I /9J
- , I
Signature of Supervising Electrician
~>d_~
. .~t::$~y / "7:>.. D. Branch Ci'rcui ts
Owners Name . r/"Z.~A!7_/~~
\ddress J"?>9 _~~~ _
Ci ty ~~ ~~Phone~~_-;;;J9~
r. ~~;;y~ r
OVNER INSTALLATIO~
$
$
$
see "B"
above
New, Alteration or Extension Per Panel
. .
l1iscellaneo~s(Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Corilm
cine .CircIli t
Each .Additional'
Cir~uit 6r wit~ Service
or Feeder Permit
E.
5.
SUBT9TAL OF' ABOVE .
5% State Surcharge
TOTAL
j'. -,
$ 35.00
$
2.00
not included)
,$
$
$
$
/i/ft?.. ~
. - 7-:<'----.
~ .:?tt:!!>
1.~1h ~o
40.00
40.00
20.00
36.00