HomeMy WebLinkAboutPermit Electrical 2002-10-22
225 FIFTH STREET'
SPRINGFIELD, OREGON 97477 :
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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ELE_CAL PERMIT APPLICATION
'city Joh Numher DZ-:- 00 7 ~D .01
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3. COMPLETE FEE SCHEDULE BELOW
I. LOCATION OF INSTALLATION I
_~r_::1 P..i i/ eA' ki:i'DIJ' Rr<4a..;.- A.
sp~l'2-b. '
--r:'EGAL DESCRIPTION
17032-:>Cr'J /1'100
New Residential-Single or
MuIti-Fmnil)' per dwelling unit.
Sen'ice Included:
Items Cost
SUIJl
JOB DESCRIPTION The following project as submitted has thdOOlll'8ipIJ, or Jess
~'-" r, -1- y -,- S .J-.efQ!JI!39 and does not require specific 1'I'l9d1i'9ddilional 500
. I .:....."'..,...01. d-i:;V s.q. ft 0: portion
Permits arc non-transferable and e~flJ&g .,~""J"'V~
if work is nol slaned wilhllal<8O-<'-,:, \ 0 ~1,1,.- 0 'f;"-::h..M:lnufd Home or
of issuance or if work is sW.lll1llllxQj'!f;gnature ~J Modular Dwelling
180 days, Service or Feeder
$106,00
$ ]9.00
$ 50,00
2, CONTRACTOR INSTALLATION ONLY
B. Sen'ices or Feeders
Iostallation, Alterations or
Relocation:
Eleclrical'Contractor !>..~'" S,,~~5
City ~~.;.:
" ,
S.,--/L!~ Sl-
Phone 7'1'-/--9<1 Lf'!
200 amps or less
20 I a;nps to 400 amps
40 I amps to. 600 amps
60 I amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 63,00
~ $ 75,00
$125,00
$163,00
$375,00
$ 50,00
Addrcss (0 ~ <.,
/
Snpervisor License Number J L{7 d LEP
. , ,
Expiration Date ! () - / - (:) C)
" Constr Contr, Number (r'P d-- ~ .3
Expiration Dale ;]>i::, -0 'f
C. Temporary Sen'ices or Feeders
Installation, AIteratioo or Relocation
200 amps or less
201 amps to 400amps
'- .- Oy~r 40 I to 600 amps
Over 600 amps or 1000 volts ~'(O
"8" above te~U\tes~~\\\\W
e~o{l \a'lll e Ote~o{l \ \Onn
D._Bli'l~'.~r\\~~'o~\n lesatese ..()O'-
Owners Name .C:;tA-;J fM-P-o'i1C."O p...'\r\::'\"u\~dRReraHflI)si~~'il~~~~
I \o\lo'lll~o{lcen\e\O\ntOU~ o\\netU {Ie
Address ~3 f}O b..,..J &-"....,rp ~40\\\\ca:~5i~lUi,Q~\.'e.\{lCO~\~stle\9\e~~~ $4300 _
_ t (\ Op,.~ tl'a~ 0'0 \NO\e. ~ . NO\i\\C
Phone 9> s-7 8/ 8M '0090. ~OE.l~.ell!lft'ill"Iiill~I\~~~Service
ca\\,{I~T&~~~'{!o0-332- ~ $ 3,00
OWNER INSTALLATION {lU1tI'oet e{l\8tiS~-
The installation is being made on E, Miscclf:ineous (Service/feeder not included)
properly I o\\'ll which is nol intended , -Each installalion 't..
for sale, lease or rent. Pump or irrigation \~t. ~$50,OO _
SignfOlltlin~~t.. \f \~\$5~00 _
Owners Signature: ~\~nlItedI,11't(!i.~e: ~t.~\ofI\\ f~ $z,,00p2.,,-
~~\c;, ~t\\1l!\~~"~~~~\)Q~t.\) - $4500_
l\IiI1~~~~~t~(}'i\'!S[lecti()n Fcc is S45.00 + Sll~targes
4. ~ OF ABOVE C{I
7 0 State Sureharue 71>
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8% Administrative Fee J{, e,
TOTAL ~~ ?S-
$50,00
$69,00
$100,00
Signature of SUllcn'ising Electrician
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