HomeMy WebLinkAboutPermit Electrical 1997-12-12
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Authorized Signature () Y\A
225 FIFTH STRE~l '
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
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t ~ (:)~ ~ ELECTRICAL PERMIT APPLICATION
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~-o ~ ~ ~ City Job Number Cf<soCl II
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~ ...,~~ \?O!JJLETE FEE SCHEDULE BELOI/
1. LOCATION OF INSTALLATION ' "% ~ ~.
I?,Lt S- R~~ DV-t J-.L- ~1l.~ ~l.idential-Single or
~~i.:-.amily per dwelling uni to
LEGAL DESCRIPTION . %;~e~cluded:
17D'3;;', /.} 3 D '3l/-00 :"9 V,>- Items Cost
JOB DESCRIPTIO/i
Nu.v Vr(lJ.L! *.$
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractori1..J cJ40..ll~
J
Ad dr es s t.f.Jo:>
'^-' &......
I
I!,
CitY_~":' Phone l..f<',,;uc;.s-
Supervisor License Number ~~~
,'"
Expiration Date
/ D -1- 1 P
Cons t r Con t r. Number.,20 ~ I ~
Expiration Date
//}-/-9 !(
Si~,re tfJS~ViSing Electrician
/A/A-}I.~ I
~wn:rs Name 1=.1<.100 I DAL.L ; OS
Address \<ilRb S+n
Ci ty 5pv~ At1 ti JJ cl Phone 7 tJ 10 - e>7<1 t
OVNER INSTALLATION
'.':
The 'installation. is being made on
'property I own which is not intended
. for. .sale, .lease. or ren t.
. .
Owners Signa~u~e:
---------------------------------------
DATE: ;).0 rJ~ h..A.. \9 q-,
RECEIPT- 11: .;),9P [" OJ
RECEIVED BY: ~0
1000 sq,ft. or less
Each additional 500
sq, ft or portion
thereof
Each Manuf'd Home. or
Modular Dwelling
Service or Feeder
B.
Services or Feeders
Installation, Alterations
or Relocation:
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
Sum
$ 85,00
$ 15.00
$ 40.00
$ 50,00
$ 60,00"
$100:00 '
$130:00"
$300...00
$ 40.00
C.
Temporary Services or. Feeders
Installation, Alteration or Relocation
I '
200 amps' 'OT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B" above
.'
New, Alteration or Extension Per Panel
One Circuit \
Each Additional
Circuit or with Servic~'
or Feeder Permit 'I
$ 35,00 f3<;;,--'
$ 2.00:ti 1<6. -
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not'.:included)
.'
4b:bo
40>00
20.00
36.00
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
~53,-
"\ do, ~
~ 1,5'1
$' '57, d-':!:-