HomeMy WebLinkAboutPermit Electrical 1996-7-24
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'5'503726 3689
SPFD DEV. SER.
141002
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10:55
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'The following project as su mea' s e>
zoning, and does not req fa sp0CiTlc land u,
approval. 11,'
Zoning l..,C.../
225 FIFTH STREET ' .. Dea;)/~
SPRINGFIELD, OREGON 97477 ~~Slgnature n M
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELECTRICAL PERMIT APPLICATION L ~
City Job Number C\ ~ () ~3
1. LOCftTION OF INSTALLATION
~-S-/Jf Q) $/ -SoR../IlX1tFieUJ. A. New Residential-Single or
. /'1 03 ;).~ ;>q05503Multi-Family per dwelling unit.
LEGAL DESCRIPTION F, '-<10-:, , Sel:vice Included: ' "
,. I T kE kc) ~.t\-,:) S ,IJt(l~O~i1t ~?,. Items Cos t
'/'} '~. 'VI'; 10 ' .
'7'") JOB DES.CRIPTION 00.9. O-<1,<y"c!;QQ (,,~.s- ~b 1000 .c;q. ft. or less
r n L..E: :s l (1 n) '" ~ '- ~t~ ~ ('I c!;oo ~~ Each addi tional 500
, /'}(.I,-~~' '0(" "Oa.......,/~/O/<9 O/'}hsq. ft or portion
Permi ts arB, non-transferab~ ~.d ~~y~ ;.:- )-. IYOJ.- ~Itt'!ereof
if work is not started withi~Ii[?~C'!d'a~Vl'o ~~ &(~);I.anuf'd Home. or
of issuance or if work is s~E!~e~~~~ ~I';) &r~~~u~~'Dwelling
180 days. ?&r:> 01'; ;':-IIV, "90( ~.9~ ~~~~&J Feeder
/.s- l'. &.90 0,& ~ ~ O-i c!;r& ~. '0
2. CONTRACTOR INSTALLATION ONLY '<900. ~ ~:"1~' o~/t<>>~ e'e,s ~ Feeders
i I '0>01 1'P'yl&I&I~.;~i?~n, Alterations
Electrical Contractor HEA'T)-l S"i~JEl.~''Vo".&~:t~F'~,non:
1 J '~I . ~ ' ~~ "~o. o/'}& OJ.-
Address 'Y~J..j'1 :s C. / 7 ' . 2~~mps or less
U ; 201 a.mps to 400 amps
CitYfTLD18~'i7;;()2Phonr(s-Z;3)..23:J-::;(,:>O 401 amps to 600 amps
/. ~ - 601 amps to 1000 amps
Supervisor License Number :;;tt,-r9f? t'iS Over 1000 amps/volts
. Reconnect Only
Expira tion Da te /0// /7'1f '
/ / C. Temporary Services or Feeders
Constr Contr~umber ~;?17~;7~ Installation, Alteration or Relocation
EXPiL"at~n~~ //~ 7/0C> 200 amps"'or less $ 40.00
~ ~ ....0 .<:' / / 201 amps to 400 amps $ 55.00 .
s~~~~~~:;~~ g~:~ :g~ ~~p~o~"a~g~o volts :e:o~g? above
, -: ~ '\o_4~ r D. Branch Circuits ,"
Owners ~m~6jL>72~
~ /o.Y.P~ New, Alteration or Extension Per Panel
Address9~~ ~~4KAtV~2S On:'
';) <!\)'~~ j
Ci tylT.iZ> I O~?i.%7I'hone c28s","/7.1y-
/ . -& .~ ~
O\INER INSTAL~~ ~'*=
~~Q
The installation i~e~~de on
property I own whi c:n is ::no{ . in tended
for sale, lease or rent.
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting J(
Limited Energy/Res
Limited Energy/Camm
3 COMPLETE FEE SCHEDULEBELOY
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
E.
Owners Signature:
,....
DATE;----------:-~--rr~~~~~--
RECEIPT #: \~,\! ,-J..d f )
RECEIVED BY: J J \' \ ~ -
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5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
Sum
$ 85.00
$ 15.00
. $ 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
$ 35.00
$ 2.00
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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