HomeMy WebLinkAboutPermit Electrical 1992-1-27
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. ,,~:i~~tiCTRlCAL PERMIT APPLICATION
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,,': "~<:1) COMPLETE FEE SCHEDULE BELOII
1. Lf/.?tpr (JlO~l~~I~A,TION " -. :::' :'.: ~~V""N': Resi tial-Single or
, .'. .... r;,~\J t amily per dwelling uni to
LEGAL DESCRIPTION ..:,. .::.a, '1"\''-)' ~>.. vice Included:
I "1 D 'J 7/~;/'?; '2- 0 7/ vvv . /:,~:'/ Items Cos t
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JO.B DESCRIPTION /" . ....'}.'.. 1000 sq.ft. or less
t,n JU ) ,.I:ultT. r I J rmY.lJ W J 5\ KW Each addi tional 500
'"'"T I sq. ft or portion
Permits are non-transferable and expire thereof
if work is not started within 180 days Each Manuf'd Home or
of issuance or if work is suspended for Modular Dwelling
'180 days. Service or Feeder
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
Sum
$ 85.00
$ 15.00
$ 40.00
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractorcr.,S flOOfltIl'lI\ ~..
Address p.O. fb-L I~ g 1-.
,
Ci ty~ Phone 14/ -1..1. 210
Supervisor License Number I b 8 b 8
Expiration Date IO-/~qL
Constr Contr. Number O:? ~<J-q
Expiration Date ' q-/~q~
B. .Services or Feeders
Installation, Alterations or
Relocation:
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps 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
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Owners Name '3J\1'1fnk. (~Tli\t ,~
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Add res s-14.t'l rv II; mn 6 t-:
CitY~JUfn~F~PhOne '14fo- 4.J.!1.l
OIlNER INSTALLATION
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit $ 35.00 15.00
Each Addi tional
Circuit or with Service
or Feeder Permit ~ $ 2.00 t.oo
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E. Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
Owners Signature:
;(1.0()
1 '~:l
=?~. 85
5. SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
DATE: ('?-7 -q-z..--
RECEIPT 1I: -'2. C;'l?q
RECEIVED BY: (I iw-./- r")
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