HomeMy WebLinkAboutPermit Electrical 2001-10-30
ELECI'RlCAL PERMIT APPLICATION
~.()\ City Job Number \)\. O\\QC\. .(')\
\~'\1 3, COMPLETE FEE SCHEDULE BELOW
TI.Qtl \F'
~ A. New Residential-Single or
Molt! -FamiJy per dwelling unit
SeIViae Included:
.
.
22' FIFTH STREET
SPRINGF!El.D, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-37'9
L
LEGAL D~CRIcrl
ptf:l'O';:A''6
~-n~
.~t\4-~
1000 sq.ft. or less
Each additional 500
sq. 1\ or portion
thereof
Each Manufd Home or
Modular Dwelling
Service or Feeder
2, CONl'RACI'OR INST ALLA TION ONLY B. Services or Feeders
o / r ~ Jnno.l1"Jltion. Alterations or
Electrical ConlIactor.f1'Jh /-. '"Ap/{ Yee.:z: PI C-- Relocation:
Address / ~ D k, l nz: S hI" r if II ;/<7-> 200 amps or less
? "I"
(.) 20 I amps 10 4Q0 amps
City C Wji-"P~ Phone r:;,P-Q-')9?.J 401 amps 10 600 amps
C" 601 amps 10 1000 amps
SUpeMsor License Number 3<J//' 5-::-",,) Over 1000 ampslvolts
of /'J R____~,__l Only
Expiration Dale U/ - tJ I ~ kn-/ /.f~
,
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ConslI ConlI, Number 9 h:J rJ,5
Expiration Date J- .2 S~ - .8 2---
C. Tc....,._-~J Services or Feeders
Installation, Alleration or Relocation
Signatute of Supervising Electrician
200 amps or less
20 I amps to 400 amps
O\'CI 401 to 600 amps
Over 600 amps or 1000 volts see
"B" above
1VdR-+~~
Owners Name ~\\ \)Q.t\ ~
Address_~ l<\:i5
City ~ '\"\0 I\n. Phon;r\,4-.1.ld.6)
O~STALLATION
Items Cost Sum
-L$106,OO J.Q1o
~ $ 19,00 :lli>
$ 50,00
_$63,00_
_$75,00_
$125,00
$163,00
$375,00
S 50,00
. -L $50,00 l5Q
_ 569,00
_$100.00_
D, Branch Circuits
New Allern.tion or Extension Per Panel
One Circuit
$43.00
Each Additional Circuil or with Service
or Feeder Permit
E, Miscellaneous (Service/feeder nCI i"c1uded)
-Each installation
Pump or irrigation
SignlOulline Lighting
Limited EnergylRes
Limited Energy/Comm
The installation is being made on
property 1 own which is not intended
for sale, lease or rent
OwnCI3 Signature:
$ 3,00
$50.00
$.50,00
$25,00
$45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surc:harges
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
TOTAL
~i
ctJulo.8D