HomeMy WebLinkAboutPermit Electrical 1997-12-4
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225 FIFTH STREET D.;;' I ~ -c,"'7
SPRINGFIELD, OREGON 97477 ~
INSPECTION REQUEST: Alt26~Y169n'lure n "'^
OFFICE: 726-3759
1. J H>CA.TIObr .INSTAl#~IQN-t ,. +-
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~B DESCRIPTIO~ ~
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Permits are non-transferable and expire
if york is not started vithin 180 days
of issuance or if york is suspended for
180 days.
ELECTRICAL PERMIT APPLICATION
r;i ty Job Numb7rq ,11, <{, "
3. COMPLETE FEE SCHEDULE BELO\1
Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
Sum
1000 sQ.ft. or less
Each additional 500
SQ. ft or portion
thereof
Each Manuf'd Home. or
Modular. 'Dvelling-
Service or Feeder
$ 85.00
$ 15.00
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
2. CONTRACTOR INSTALLATION ONLY .B.
Electrical Contrac tor\2.s:'l- "~tl&n..)>:. .\F'r-h-\ c....
~ n~'i~ .
Addressd-.\)"'::, W" d-').....~~~7A~ : 200 amps or less $ 50.00
''''.or.,- 201 amps to 400 amps $ 60.00
CityJ~U.Q.~^,f, plwlt., ~~~ 401 amI's to_ 600 amps $100.00
\. ''''l?-f.' ~'::~,~-'<( ~ 601 amps to 1000 amps $130.00
Supervisor License Number ~~~?~~i' '-:.rAt.: Over 1000 amps/volts $300.00 -:\
\0 -,' ~o=>~J-,o ..~.{s> ~ f9~~Reconnect Only I $ 40.00 '4-flJ!U
Expiration Date - \" ~,o_ "/,0 7.s',o ~
-t.O -4-a CS9~T rary Services or Feeders .
Constr Contr. Number \'d-.h:):;}. . O"'~/' 7t~t ~tion, Alteration or Relocation
vA "'0
Expiration Date ;),"1. -~ Cf, ~O ?ntps"or less $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
Signature of Supervising Electrician
W~'~~/"7~-- ../
O~ Name U ~ Lirv)a~ H?"{)(tj-D.
Address I /1. () nOr /! J VI 7. i R-
Ci ty ell a P n R Phone JJ1..Lf - / it? 2-&
01lNER ~NSTALLATION
The installation is being made on E.
property I ovn vhich is not intended
for sale, lease or rent.
Ovner~~ignature:
--
DATE~--------\~-A.l1-\ _-~~--------- 5.
RECEIPT 1I:. .r\..]:'>\ I~.~
RECEIVED BY: \I'.
Branch Circuits
"
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or- Feeder Permit
$ 35.00
$ 2.00
Miscellaneous (Serviceifeeder
-Each installation
Pump or irrigation
Sign/Outline Lightin~
Limited Energy/Res
Limited Energy/Comm
not included)
40.00
40.00
20.00
36.00
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
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