HomeMy WebLinkAboutPermit Electrical 2002-3-6
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELECTRICAL PERMIT APPLICATION
City Job Number 00 - 0/ L( b/ - 0 I
3. COMPLETE FEE SCHEDULE BELOW
~; .
1. LOCATION OF INSTALLATION
L.; 6 '8.r ~S'7:
LEGAL DESCRIPTIC)N \l 01:..?fUX)ca::{O 7
7~ l/v(t~ ~7}f-7'l,..'"l"'
:: A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost
sum
JOB DESCRIPTION ,
~~0fL 70 ~/L~~ v4lc
1000 sq. ft. or less ,
Each additional,500
sq. ft or portion
$106.00
:emiits .are non-transfe~a~le at,l,(h3f16~T. thereof
If work IS not started wIthm li&QI~y~h~g prOject as sub' Each Manufd Home or
of issuance or if work is suspeifdeUor does not reqUi~'tstped hClMbdtMlffi n~elling
. ecifiO'I"..... 11I71,
180 days. . ion' . ;:)et'Vic/4Ser eeder
mg
Date
2. CONTRACTOR INST ALLA TIoN-e
" AUit10rizea S'
, 4' Ignature
Electrical Contractor ~ ~ <
$ 19.00
$ 50.00
Address~L 7( e-v.l.....;Q _ ~ 200 amps or less. I $ 63.00 ~ '3 ~
201 amps to 400 amps $ 75.00
City-b'v~ Phone '3 Lt 3- ?;tq.7 401 amps to 600 amps $125.00
601 amps to 1000 amps $163.00
Supe,rvisor License Num~er ef2.o -/ ss-- c:::.... Over 1000 amps/volts $375.00
. ou.o
~ee0nnect/G)nl~"p0.i)n la'll! raq:.mes Y $ 50.00
NOTIC!piration Date' /0 ,.... 0 Z- fvl;f~'~;'i:~"l~~ '~d~~t~d by the Oregon U~i.~~Y
. . C. Temporary ~\er~iRr.sd?t~e~d$.f;~er. Those rules are~el ~~Jrth
THIS PE~I@I:fA\d:, ~m6Ui IFTH~~5' 2- . InstrP~~~'H,~~Ll\991\XlJ1~tt10;G:ati~\] OfR 9o~~v01-
AUTHORIZED UNDERTHISY~RMITIS~OT on90. You may obtain copies 01 the rules by
COMME~~~ ~~~NDO~~ Po: t 7B~lmPJ'~IR~ l~~lter.. (Not~: ,t~e telepho~~50.00
'. ~B~~6~ ~9B ~p~on utility NctltlCatll$g9.00
ANY 1805?~~~ervi~ing Electrician '(jver 40tt~@P!~P$OO-332-2344). $100.00
Over 600 amps or 1000 volts see
"B" above
jZ:rs Name
~
/'
D. Branch Circuits
~
New, Alteration or Extension Per Panel
Address ~D ~\) 'I- I 'I 7
One Circuit
$43.00
City~~I'I~Phone qt,<->J?&'? /
OWNER INSTALLATION -
Each Additional Circuit or with Service "7
or Feeder Penn it ;> $ 3.00 ~
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 $50.00
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
$50.00
$25.00
$45.00
Owners Signature:
no ~ mIHm-;lJ
: 38N\:JHJ
08'Z8 $ z:aJ3~ lWtJ
GOO: 90 ~\:JW:31\:JQ
~~G8000-10:~SN\:J~1
TOTAL
72
':) 0'1
5" 7'
gZ ~6
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee