HomeMy WebLinkAboutPermit Electrical 2002-4-16
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
1.
LOCATION OF INSTALLAT. IONL, ,/
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
~i~ture of Supervising Electrician
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Address 3dO '3> IJ I /f~ /31
Ci ty ( - LA.. C Phone S?o/, .-- 7' J~
Owners Name
OVNER INSTALLATION
The installation is being made on
property I ,own whi~h is not intended
, for sale, lease or rent.
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:39N~~0~ers Signature:
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GOOG 91 ~d~:31~a
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DATE:
RECEIPT #: &hZ6
RECEIVED BY:
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DATif:APR 16 2002
AMTRECD:2 $ 209.30
CHANGE:
CASHIER:061
ELECTRICAL PERMIT APPLICATION
rLty Job Number () Z -00 /I ~;O I
3. COMPLETE FEE SCHEDULE BELOY
A.
$ 2.00
Sum
lOb
7b
,.
not included)
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
40.00
40.00
20.00
36,00
The following project as submitted has the following
zoning, and does not require specific land use
approval.
Zoning, f.n(2.
9740rJe ~-ICd-O h
7 zr6ill3>7i6~ Signature t<uJ
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items' Cos t
1000 sq. ft. or less .1<\\" $ ~OO
Each addi tional ~~p~;,:~<,,,'J0,,,~
s,q~., ft or p~r:t,i'0n,',:r.~"I,;tt.~0"
.-f'\'tP'E.ereo,t\"',\ '~. c:'(,~;:,." ",", $..-r5:"'00
\~.., 'E~f.p.:(ffarfJ:f i~~)lWd!li~'-9-~'~C,i \.'.j:'
,,\\..~~M~~YJ.'l\,;-!'~~~~'P!.~l1g \~o#' "
I";";~C~. "OfJ.l;;,"Feeder . $ 40,00
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2. CONTRACTOR INSTALLATION ONLYB. ~{ff\'~'t~~eedert '
~ # Ii !J ....,' ' . Ii\1t6i'!l"ation, Alterations
Electrical contractor~rdf:fIJ!f bl'c. m-' Relocation:
Address Po Olx))( 4;>[)/ L-: 200 amps or less $ 50.00
201 amps to 400 amps $ 60.00
City EUtl{/IJlO Phone~/ 2,6W 401 amps to 600 amps $100.00
v~ 601 amps to 1000 amps $130.00,
Supervi.sor License Number 1553.s over't.QOO amps/volts $300.00
I / ~~~~t Only' $ 40.00
Expiration Date iOtl /()4 ~~ ~-:>O~~3?~o~ ' .
I I ~ ~~"6~.~~~vices or Feeders
Constr Contr. Number l~o/2-1 ~'~~~Ji;1~~~~tlteration or Relocation
#1 -:>0 ~ ~19~/0&~"~ k
Expiration Date la '. 03 ~6)2'~<S&~~'~#o1~ $ 40.00
~b~~~.~~~s $ 55.00
0~f9~ V'~~~~ ~i!'~ $ 80.00
ov~ ~ ~~c91&v~~()vOl ts see "B" above
~:.66) .....($) V~ ~ 6)~:;i'~
D. BrancW~~~~ <(;,~~~ &9~
Q. ~ v ~ ~ ~ .~~ ~("
New, Alt~\P~~.~ J:}pt?ension Per Panel
Y; ...... ~o ~Ooa
1/. ~.~ V
One Circuit~ ~.~o ~ $ 35.00
Each Addi tion~ g.. ~
Circuit or with Service
or Feeder Permit
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administra~ive Fee
TOTAL
$
$
$
$
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