HomeMy WebLinkAboutPermit Electrical 2001-8-18
r.owing project 8S submftted has the following
z. and does not require specific land use
225 FIFTH STREET approval. ~D ~
SPRINGFIELD OREGON 97477 Zoni!)ll
INSPECTION REQUEST: D7U-J.7~g ~ \ \ q 0\, ~;\ ~ '~..ber 0 I -0 c:r 87'-1 - 0 I
OFFICE: 726-3759 ~
Authorizad Signature j, lUMPLETE FEE SCHEDULE BELOW
.
ELECTRICAL PERMIT APPLlCA TION
.
1. LJC~;;ON~?~:Z ~L:Jt.N
I
LEGAL DESCRIPTION (
171J53~1
JOB ~~CRJPTION-j)
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. U
Pennits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
o b'-tl'f
A. New Residentia1-Single or
Multi-Family per dwelling unit
Service Included: '
1000 sq.ft. or less
Each additional 500
sq, ft or portion
thereof
Each Manufd Home or
Modular Dwelling
Service or Feeder
.
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
lnsta1lation, Alterations or
Electrical Contractor_k S E 1(' c tf It:. ') ~ . Relocation:
Address (P.O.~, .' ?_ V9 ~ -.;; 200 amps or less
'/'
S 201 amps to 400 amps
City / o.AQ Pho~ W'i9 - 62.} -6 401 amps to 600 amps
U 601 amps to 1000 amps
Supervisor License Number 3 ""97 S Over 1000 amps/volts
, / Reconnect Only
Expiration Date I()/~/ 0 I
Constr Contr. Number 70 .? rf' 7'
Expiration Date /2.-? 0/ CJ </
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Signature of Supervising Electrician
J-~ 1.1 jr~7~
r-::ers Name k" ~ 'cJ-a it ~S
200 amps or less
201 amps to 400 amps
Over 40 I to 600 amps
Over 600 amps or 1000 volts see
"B" above
D, Branch Circuits
New, Alteration or Extension Per Panel
Address PZO 'J.A1...IoV etC.-
I
City S if /-.0 Phone 72. (, -07 F7
O~R'INSTALLATION
One Circuit
Items Cost
Sum
5106,00
519.00
$ 50,00
$ 63.00
_$75.00_
$125,00
5163.00
$375.00
5 50,00
550,00
569.00
5100.00
-1- 543.00 _
Each Additional Circuit or with Service
or Feeder Pennit $ 3,00
The installation is being made on
property r own which is not intended
for sale, lease or rent.
E, Miscellaneous (Service/feeder not included)
-Each installation
Pump or inigation
Sign/Outline Lightiruz
Umited EnergylRes
Umited Energy/Corom
5, SUBTOTAL OF ABOVE II A
7% State Surcharge , ' \' V
8% Administrative Fee 19 "\
TOTAL
Owners Signature:
l:on:t13IH8U~
.\JH:J
~u ,~ $ G:O:J3t1 lW\J
l:OOG H 9n\J:31\JO
VGV9000-l:0:#SN~~1
$50.00
$50,00
$25.00
$45,00
c { 7)..-
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