HomeMy WebLinkAboutPermit Electrical 2000-11-21
The following project as sUbmittepde~~~ t~:nf~\~os~ing
zoning, and does not require s
approval, J.J:;If-
225 FIFTH STREET Zoning
SPRINGFIELD, OREGON 97477 (J" ~I - c:r'I>
INSPEC:ION ~QUEgWte 72G, 3759 -~
OFFICE. 726-37 59 AuthoriZed Signature
3. COMPLETE FEE SCHEDULE BELOV
TRANS#:Ol-0003847
DA IE: NO',) 21 2000
AMT RECD:2 $ 95.70
ELECTRICAL PERMIT APPLICATION CHANGE:
, CASHJER:059
Ci ty Job Number 00- (); r{J3.,.-U I
1.
LOC~ON OF INSTALLATION
,:J~ ) "A \ \ ~V\ (4 \.(..E
A. New Residential-Single or
Multi-Family per dwelling uni t .
Service Included:
Items Cost Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home, or
Modular "Dwelling
Service or Feeder $, 40.00
LEGAL DESCRIPTION
/::;-.03;;). -S3:> OL/.jO(Y
~B DES~RIP~ION\\ ,
'-1. C, r (U,i-r
Permits aLe non-transferable and expire
if work is not started idthin 180 days
of issuance or if work is suspended for
180 days,
2. CONTRACTOR INSTALLATION ONLY ,B. Services or Feeders
Installation, Alterations
Electdcal Contractor A~\t... ~le(A-(J\r; or Relocation:
Addressj3C)n vJ.vtd..O.VSOh L-i4rU/ _ A: 200 amps or less $ 50.00
, It!iO,., 201 amps to 400 amps S 60.00
Ci ty <-rFL.. D ,_ Phone, '11..& - ~ 10 :)i~" lCLL?Ol amps to, 600 amps $100,00
_ . ~ fA uP~A ?Ol amps to 1000 amps $130.00_
Supervi. S('lr Li cense Numoer ..) 13- 2- 3 A,(/"J""fiOR. '/i/Qpe'f.ll000 amps/volts $300.00
/ " CO/VIP" ~..?ERe~o~n.~E::k Only $ 40.00
Expi ra t ion Da te /0 0 I / () / _,!,/II.' fV/~fVC I.JUIVDl2fh. "p/f.,"c./;:-...
_ '! 78,OuC. l3'L;f(@'m:Dorad~Z"cS;ervi.6e"SA,or Feeders
n 'IS I'- I II ~ \.. ' /"\' JI <.) 1"1:; ... /tf/n
Cons t r Con t r, Numbe r '"1 cI-' l)\..fI r Ptns t\alJli]"~iv,on.8/h/~~t~ra/~'i;on or Reloca t i on
1'1/0D vO/V"', IS IVO
Expiration Date ~ 1/0 J <'9-3 200 a'mps"o-r f~l~)R / $ 40.00
, . 201 amps to 400 amps $ 55.00
Signature of Supervising Electrician Over 401 to 600 amps $ 80.00
L- to' Over 600 amps or 1000 vol ts see "B" above
~~ ~ ~I
Ovners Signature:
L D. Branch Circui ts
Amh "'/1
,; I c--. ",,' 'c1;1:(lNe~:I,<'Al t~~l'?;,tion or Extension Per Panel
f-I\. 'c:.... v<"Of) 7 ,,1::1, i' ! !he O,Lt., &~ ,. '
'. , "-00 f7OSr;.' r(:l@ .101.1 "~ t
f}L/ L( . Ssm' naJJ 0 1l0o,e tzil!..P{:Ul...tOf} U~' " ~ \ $ 35.00
Phone 7' " .~ btaiIEaeN./(P:da~i{t/i'onal.1itt,
','r,.. '(.... ""It)" -;:;t-!~.. "
, . - IElJ I' GiC'licui t'A,6~~I'.wi t1h>-1Service
,-) ,i'ie, -,' 06;' :1,;) ".;" \ $
, I:..;''JO' or;" if7%~Ue't:, r;Pe~m_17~ 2.00
" ,/' I...lrj/i/l .... rE)/aj.)h utes b!
E. M'i-sce'l'\1-cmeo1J'S~ (Se~v i eel feeder no t i ncl uc€d
E '"h" '-"/J1'>"~:1- .
- ac '~.~rs t'aJJ!S-i~ t 1 on
Pump or'irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
~s/
'/'
?-
Owners Name ~ \ VV\
Address g.5_~ 'ALL E \'\
Ci tyC0f~nt..t:;.,\A
-.-J\ ,I -J
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
-----------------------------------~---
5.
SUBTOTAL OF ABOVE
7% State Surcharge
3% Administrative Fee
TOTAL
S
$
S
$
~,f) /'
:<',5'1
/, IJ
t.( 0, 7-0
40.00
40.00
20.00
36.00
DATE:
RECEIPT #:
RECEIVED BY: