HomeMy WebLinkAboutPermit Electrical 2006-10-11
,225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · F~,(: (541)726-3689
ELEcl KlCAL PERMIT APPLICATION,
City Job Number r 1/M ~OD 19 ...;.. 002?5Lo Date J a-II - \01.0
1.
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LEGAL DESCRIPTION
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I A.
JOB DESCRlPTION( ~a Ff+4fcorn ;}()o& _ 1000 sq. ~ orless ,
, , Each additIonal 500 sq. ft. ,or
f\je..u.) Lt)',n"r\.aI Cf\ A-rlcUffill ODd-8iR) portion thereof '
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" 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.
Electrical Contractor rn ,+ ,IJe Fu= :t 1>1 c:
Address 2fd D r1I1~}<\r-r.~LX=
City EJr..6t.F- 01(,{. Phone 5Z1-c;iy<y 0
Supervisor License Number L.j 7 7 'A S
Expiration Date i 0 - c I - D I
Constr. Contr. Number I Lj , 7'-1",-
Expiration Date u 1- I Y' - 0 -,
Signature of Supervising Electrician
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L.N~:~~iM g (j.riSSL. V3r<ck
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Address ;)-r(~ 7 Bur l f,~tI A-ve.
City~r~-t10d Phone '7 If? "'-8D1 g
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
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Inspection Request: 726-3769
Service Included
$106,00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
I
$63.00 ((J~
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.
Installation, Alteration or Relocation
200 Amps or less $ 50.00
Neqtl~~s to 400 Amps $ 69.00
TH1%l ~ft~~~~XPIRE IF T!-!~ \WRKOO.oo
A
e
A~~ ~tth\~o5\n,UOO~nsion Per Panel
One Circuit $ 43.00
Each Additional Circuit or with ') I
Service or Feeder Pennit rJ $, 3.00 ~
E.
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p":,m'p',1\or llmicm.t,iouiopted by the Oregon l$t~b~oo
I"\:ft '"'.. . '"co"" f t'
r&igpJ.0.utline,lli'gntiilar. Those rules are sf$t5tY.oo
'IIJ-:;.;,'~;;er::i)J'o.1_(,)"dn1tJ.Q +lhrough UAH ~5$~?Q0010
lIDlreul Etner-gy/Kesl en. a . . .._ _, I-:l.. \
t;\0.O.{) \l..'"lll m1i1\/ obtain r.OpI8i:) VI U Iv I U e::i iJ"
'~mllted ~nergy7Gommerclal te' t'^^ +",I"l"\hb~5.,00
calling me center. tl\lO . "-, '-'~.':. .'''
Minim urn, 'If.! ectr.ic-Rrel'-mit-Ins'r',.ectioIitE'e. 'el iSJ$4SI.lO'Ol.:f.: S urchan.!:es
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Shared Drive(T:)lBuilding Forms/Elecli;cal Permit Application 1-03,doc
7% State Surcharge
10% Administrative Fee
C::;'/ ~ 'T e cJ;.. -R.L-
TOTAL ,