HomeMy WebLinkAboutPermit Electrical 1991-1-1
225 U.~.O STREET
'SPRINGFIELD, OREGON 97477
',INSPECrION REQUEST: 726-3769'
OFFICE: ' '726-3759
1. ~~F ~~TIA\s\ Q'~~
LEGAL DESCRIPTION
" ...JJ>B"...D~PTIO'.....I f\ 11
Q,," \! Q [)Ac J. Q (\I~
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
to. (.q,Q
Expiration Date
'Constr Co~tr. Number '?') ~R~L0
Expiration Date c9. <9 .q Q
I
ELECTRICAL PERHIT APPLICATION
, CityJobNumber' q\ ()l () ~4
3. COHPLETE FEE SCBEDULE BELOV
A. New Residential-Single or
, Hulti-Family per dwelling unit.
Service Included:
Items Cost Sum
1500 sq;ft. or less I $ 85.00 . 0
q,).O ,
Each additional 500
sq. ft or portion / ,/): tJc)
thereof $ 15.00 '
Each Manuf'd Home or
Modular Dwelling,
Service or Feeder $ 35.00
$ 35.00,
$ 60.00
$ 90.00
$130.00
$300.00
$ 35.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less ($ 35.00 J>: t) 8
201 amps to 400 amps. $ 40.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
Signa~of supervi~~g,Electr~cian
,'Lv' ~ ~..
, Owners Na,me . ~ i 't-( I' 1\ 0 ' :~.
Addr~ss ' ~qq , t' US. _
City 'E<, )r;4fD~ ~Pho~e <653\1(0
OVNER IJs\rALLATION
2. CONTRACTOR INSTALLATION ONLY. B. Services or Feeders (10 Branch Circuits
1.\ _ ~ '~ included). Installation, Alterations
Electrical Contracto~~} .()()J1~ or Relocation:
Address f)qf)()~ f) V ,-~\\rY'Jl ~~100 amps or less
, 0 /' ' C1<'1.f\' 101 amps to 400 amps
City . \...... ffir~ .Phone--=cl.cl ~l~D1Z. 401 amps to 600 amps
. 1\ C>~ 601 amps to 1000 amps
Supervisor License Number ~'7~C)~ . Over 1000 amps/volts
Reconnec t Only .
The installation is being. made on
property, I own which is not,intended
, for sale, lease or rent,'
Owners Signature:'
DATE:
RECKIPT ,:
RECEIVED BY:
D. Branch Circuits
New, Alteration or' Extension Per Panel
One Circuit
. Two, to ten Circuits ..
Each Addt'l ten or
portion thereof
$ 35.00
$ 50.00
$ 15.00
E~ Hiscellaneous (Service/feeder not included)'
-Each installation
Pump or irrigation
Sign/Outline Lightin~
, Signal Circui t or
limited,energy, panel
5. SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
$ 36.00
$ 36.00
$ 36.00
t J >. c90
;{, ]>'
/Cfi. ? S-