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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) l:..VA4r ~ . 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)..- .;