HomeMy WebLinkAboutPermit Electrical 2002-6-6
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
- ~'
ELaCAL PERMIT APPLICATION
CilyJobNumber CJ2-oo("t:, '(-Ol
.
3. COMPLETE FEE SCHEDULE BELOW
I. LOCA nON OF It;ST ALLA,TION
I Lib) j.JLa'aywr
ST
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
LEGAL DESCRIPTION
1/03 2~32 anoo
'tled has the tollowing
JOB DESCRIPTION- The tollowlng project as s1'lJ~ ~iOtl~esBUSe
SCIl.VLc.e CtfIl-tv''1ltbnlOg, and does not reE~ch additional 500
V approval. ~Q. ft or nnrJ-.
Permits are non-transferable and expire Zoning ~Oz.!hereof . J'1
if work is not started within 180 days Date _ t? /' G? .;aCh Manufd Home or1Y'J
of issuance or if work is suspended for . d Signature b"tvllIl"r [.,t..iilll~ ~
180 d Autho"ze S' Fec:der
ays. ervlce or .(\'<'\~
~~ \\
2. CONTRACTOR 1NST ALLA TION ONLY B. Services or ~~ ~<;)
( ) S "l -, T '^" ,~~~:iIi~,~'Wations or
Electrical Contractor 1- t:: ettnG,-I-l ..... . ~~.,:~~ ((
Address ~.o. -W'/. 14lZ'1-- I:o~~\.~~ '\'t~~~~~ or less
~. ld llk1~Aa..~'\ ~~~ ~ ~I~nps to 400 amps
Ci ' t Phone ., "'t}'\i:~<;) <;)'t- ~~~ amps to 600 amps
1 \ cnl1'\~~ ~<;)~ ~~<;) q,(() 60 I amps 10 1000 amps
Supervisor License Number 't~ -, '-t :1\ ~~~ f\)r#- Over 1000 amps/volts
I I ~I I 'V<;)~ ,'b~ Reconnect Only
Expiration Date I D I' U'-t ~'\
t1(),l/i C. Temporary Services or. feeders
Constr Contr. Number ~ 'i"'1 Installation, Alteratiori'or.Relocation
,I ...~..", ''--'
. - .;:)0,.; ',t":-o,
, ..... ~.' \ .
200 Bm~s~~I~s:)~.l")r~ r_';;)4.
201 ampyo,'4,og,~l}lPJ:"J 0
o.ver,'~_O I.,so ~~9'amps".p"'.,,()<.'
._~xer'~90amJis8r'IQ!l0.'(!llts see
Q? ka .' "B" LY ,:,'-J c, '.0 ..",~
() ~. -alJUve). r - C' O'~
..... " ..:J'-. \.' ~v~c~"\ '~"\:'~.'...\",~ ;:'"
-- _ --- . _ ' _ ~ r.''<.. .,,'}'\:J r,v {j' ..=-,,-,,'1 ("~.
V ~ ...,"D"Branch.ClrcUlts'" -.)",.~'
" ~, ('\>' ..............':{'" ,,~ r
Owners Name """'Lt:--^', ........V\,.c....c.-'t'(.\ .o~ .':).) ,\0 ;...~~. rt' ~("'
,'u A~,$N"" A'~I F.r E . P I
..;:r~ ,:~'" " :,:'.;7J ~' e-:!,f";:,t~ra!l.on or xtenslOn Per ane
f1 ~ () / L \-. r' -\Q ~ ,~;'-
Address 1,6) -r1t::/JSA,v"T S' ,0 ,,\:I' ,:~/OniCircuit
;,,'\:J ~ 0.... ,...
1.('3 l/ . c. So'\! r
City :> PP D Phone.K7 - - f ,~ Each Additional Circuit or with Service
OWNER INSTALLATION or Feeder Permit
Expiration Date q \ \ \ 0'2-
Signature of Supervising Electrician
~
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lightin/!
Limited EnergyfRes
Limiled EnergyfComm
Owners Signature:
190:;J3IHS\J:J
: 38N\JH:J
~~'6L $ 6:G:J3;J lW\J
2006 90 Nnr:31\JG
8l~6000-l0:#SN\J~1
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
TOTAL
Items Cost
Sum
$106.00
$ 19.00
$ 50.00
I
I
-L $ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
6)
1
\
J
,
"
$50.00
$69.00
$100.00
.,
"
$43.00
$ 3.00
$50.00
$50.00
$25.00
$45.00
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