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HomeMy WebLinkAboutPermit Electrical 2006-10-11 (2) ZON INITIALS DATE SOURCE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number . ,SO IY1 d-OO(o- no 2-Yc.v ;.2 '! q 0 '8-,)(-- tr\l'\Cl'~ A1J-e., LEGAL DESCRIPTIOJf 1,0"3 'Z l(, \\ \ D Sc:/l~' New RcsidentiaI- Single or lVhlIti-Family per dwelling unit. Sndl'\t.\ 4=i'0ll, OK. q ') l+0'7 \ ,..\ JOB DESCRIPTION ('~^"nfn -1- .w /"1"'1)'\ 'l.,('j., - I V'-''-' U(.... ~1')'\11 i'/" L,.t; ~~.... , Of~ '(' \ AJ au l..c\' n' ~'\0\{\ ~ ld;~11fl\ ";c,l, ''C:.) (-) . Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Electrical Contractor 200 ABW~9t~s.k t? '.......... O~n \a~b1e~mB~t~B~\~'J'lDS ~ 10"'" ~be VI' '" . ft01V Addre~,.. f\:\IEN1\ \.. ""'Jo\ed 'o\} 40'1 001;,Psj.rIW6~ Aum '--. 1'" \(~V, -r\le <::6 I'D 0. Qr.:,Z,'J ~ 'o\io\N ru',;l"'C-o.n\e'. I j"'60,~~Ji1$i}.'(o' l'ODO\ A,;n~ , \ ,,"'-On '" 4 A tnfOv:;1 , 'ri";S tI..I e'<> CIty _ Phone~l(\'\hG"6\\:.J..", 801-00 \ ': cP'tfl16bOO@ ~%g~~f\~ X"-v';OP,R ~;),t:.., ~ \J '0 b'13\n rTP~wnfI~~t\@iftYx., 'nt\Of\, / h '-.toll tnQ., f (\'\0,"" NO\\l'Ce", ./ / 0090...' \he cant0 . . .. Supervisor License Num~S:f/ ca\\n"\9_ ~.....,r ~,\le /' ""'~l\l,1\'OtJl c~nt8\ is ~ Expiration Date /" "'" Installation, Alteration or Relocation ~ \ '401 Amps to 600 Amps $100.00 \c E." Over 600 Amps or ~ q~Oy'HE.tWE}R'~" above, ~O1' , '~~\1~1f'I\~JL&iy,glm EoWl\1 \SNQ1' 1\-\\S ?CRN cP 1\-\\S? r\ '\-\OR\7.ro,\j~er:HlOn ~.ttJb'\~tWVOPer Panel ~IJ\ eN~~ ornc\~J\6/).. $ 43.00 GUMM\.. ~~~hv'f5W\oo.al Circuit or with 7 f) 'J I},N'I '\?lO \-Slervice or Feeder Permit $ 3,00 \-,>Q ( K_. .4.;.1J-r" E. Miscellaneous (Service/feeder not included)-Each Installation City ~f()I)~td, Phone 047 -~()1R 1. LOCATION OF INSTALLATION 2. CONTRACTOR INSTALLATION ONLY Constr."S:::6ntr. Number _Expiration Date Signature of Supervising ElectJician Owners Name ~l\ry\ d: ell. nS")(l ./ Address ,,/0)'71"") K'urli'V\O-tT:.fl ./ OWNER INSTALLATION The installation is being made on property I own which is not int end~d [0' ,,1e, 1", se,or r:;,n,t. , Owners Ig;lture: ., -;:1 .' , /7, ~/ Y 1~~0.-, ,//7/1/ ,: '''', /- tC/- /....../ ,,:/ Inspection Request: 726-3769 SPRINGF'-I..O Date In -.l)-'OlO 3. CO~MPLETE FEE SCHEDULE BELOW Service Included 1000 sq, ft, or less Each additional 500 sq, ft, or portion thereof $106,00 $ 19,00 Each Manufact'd Home or Modular DwelJing Service or Feeder $50,00 B. Services or Feeders -Installation, Alterations or Relocation: / b3 $ 63,00 $ 75,00 $125.00 $163.00 $375.00 $ 50.00 200 Amps or less 201 Amps to 400 Amps $ 50,00 $ 69,00 2( Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50,00 $ 50,00 $ 25,00 $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 8t( b7Z- 8t(O ~ ~ Tb:-tt- ,&ff l.( to TofAL ,./.~....", ?? IIU ~---- Shared DJive(T: )/Suilding F0l111S/EJectJical Pellllit App1ication I-06,doc 4. Sf.IBTOTAL OF ABOVE 8% State Surcharge 10% Administrative Fee