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HomeMy WebLinkAboutPermit Electrical 2002-11-4 , . . 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 ELECTRICAL PERMIT APPLICATION City Job Number CO WI zoo Z. - 0 j 2 'Z. L.. 3. COMPLETE FEE SCHEDULE BELOW I. LOCATIOl'j.QF INSTALJ.<\TION <::~~~_'f k--'. - '" (oj f2.:1' 1'. ~ A. New Residential-Single or ~ 1{.rt':t~i:I:;~~':if~,;~1S '" !!:"'~m~'.:T~'0'';4. ~",~if#,~W~~"'~:;';;~~Millti~F~.~l-"" efidweIfillfHhit;~fi _+'::.:;},:If I ... V'LEGAL'D~~RIPTION.~~ - . ' " . ..;" .S' . ,;,,' ed. 'i,:" + ';, ill .. 1'~""': ,'_ /<1 'oJ ~. V', .~t '\,i.fi_ e~...f( ..,'r'~r:-,lJ,,~~t".'J' m ,. ", 1'_'....._\7.'. -,2..6 ". ""()~'vl.o .. ,. "'-:~\i\ed"a\~c\a"dll.e' .,,-"- -- .".:,>~ rterriS~Cost Sum . c suv n.eC\ .. lec\ a.. uife Sr 99,0 1'0.<\ JOA DESCRIPTION . ~';M; 00.- ,,0 1000 s ess $106.00 l.L) t..lJ>. A D - i- ~ ~.(' t' additi . - e ";99'0.' 1.0,,1,,9 100\- 0"5 portion Pennits are non-transferable and expire \ I/'I/ 0(:.. $ 19.00 if work is not started within 180 days Ie . Ill'. of issuance or if work is suspended foP" 01l~.0 S\9"" leo days. />0111" $ 50.00 200 amps or less 201 amps to 4iiamps 40 I amps to:6 . @TIps ,\V ~).:...., :v... ... 601 ~ t~uu lfmps Superviso icense Number /,I::lQ~ ~~r~lo~i~l!JP:Wvf&~: " ~oDR'ecl'~y:a: g,'O' .,.. .. . ./ \'l> .~ .g,!)^'~~ ~e: Expir~iion Dilte/O - I - 0 4- (:>,O~ ,'~ ~'4,,,,,~',, '~,~0 ..,.<1' I "'')'T''<'I''~._. S \J. .",0 R'Oct....<:- ., ,. .:>dODI .C"-. ",,~Rq!3TY\~eMJ~ R~"ee ,;~s Constr Contr. Number. ~q.,&e "9~~oO~I~#iall~son~~ter~ti(lDo~tfRelocatiOn . , Dq-:N - OC/- <c,.~' ~e<:> e~,0 f:)....t:;).....vo ~0~'~ ~~. Expiration Dare~ /) -'/ - 0." S' I"~ ^ G "....fS ",'l:200'aIDps'or~lessY' , 'O"):)v 0.... . \.' ~v r.,," \~\J. v~ ~'/; ~~ ,t!ll '!l!lPs to:,'tVO amps Signature of Supervising Electrician ~O~~ ~<(o. 9J O~ ~ 0 v0"~e~~qFio' 600 amps ~ . .~O ~~. ~~ ~~~#,600ampsorI000voltssee IT'\ /J/) . ~ \)\)9J ~,~ e'\O ~~B" above l')~/ v ~'Q v~ (). . <". ~>S D. Branch Circuits OwnersName.~ ;:-"'4' .J New, Alteration or Extens~(l.Per Panel ~~'V ~'\ tI/>~ Address \. ~ One Circuit I( '\~ \~ ~ ---L- $43.00 ..:zu. , . ~~;~ ~'\ '\:)~ City Phone. )4-'1 ~ Each A~~~~~r with Service OWNER INSTALLATION o~r~'V ~$3.00 ~ ~. ~c;) ~~~ &~ ",\),\\q:';.~~~~~.ceJfeeder not included) '" ~~ <? ~1)~ ~~ation ~ . " ~'\~'V '&~ l?J irrigation c _ \>l ~~~ <s . Outline Lightin~ C; ~~ '\ Limi,red El!ergylRes \>l Lifi\ited Energy/Col!!ffi 2. CONTRACTOR INSTALLATION ONLY B. Electrical Contracto'l)". D ~"~ ~ Address~O ta01.. ..::y:l",,~ Services or Feeders Installation, Alterations or Relocation: City The installation is being made on property I own whic)l is not intended . ',1 for sale, lease or rent. -. .f,,"1- ,en,--- Owners SigIiature: ,."..)r-lhn....t '~-'r,J" ~,' )C" 5. SUETOTAL OF ABOVE 7% State Surcharge 8% Administrative Fee TOTAL $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.pO =-- $50.00 $69.00 $100.00 $50.00 $50.00 $25.00 _ -- $45.00 - ,- -Y9a.o 3~ ^ 't0l. .5<.0 OS