HomeMy WebLinkAboutPermit Electrical 2004-1-9
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o CITY OF SLJNGFIELD, OREGON > ,.
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jec! as submitted has the following
s not require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726~~n'
ELECTRICAL PERMIT APPLICATION Date
CityJobNumber COiVIZDO'-f-ODOZO Date 1_ 7-0lj Authorized Signature
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l-q-04' -..
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I. I LOCATION OF INSTALLA110N
IIhb S A ~+
6b60 z.
LEGAL DESCRIPTION
/703.-;3 5Lf I
JOB DESCRrPTION
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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.
3. I COMPLETE FEE SCHEDULE BELOW
A. I 'New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$ I 06.00
$ 19.00
$50.00
2. I CONTRACTO~:ALLATION ONLY 1 B.I Services or Feede~s- Installation. Alterations. or Relocation:
Electrical Contractor . (\)vDD(ClJ ion 200 Amps or less $63.00
C2 ~,r 201 Amps to 400 Amps $75.00
Address I)QQ<1lo \ ':cUI U..lY'l.{'~ 401 Amps to 600 Amps $125.00
~ 1 . 601 Amps to 1000 Amps $163.00
City . ld Phone u9>lo-mCS Over 1000 AmpsIVolts $375.00
Reconnect Only $ 50.00
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Constr. Contr. Number SL\ Ll3 \
Expiration Date q - ~Or 04
Supervisor License Number
Expiration Date
Signature of Supervising Electrician
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Owners Name eXLIA.lA.S/l) eZf A~\A t:\"'
Address "3 i 7 vJ 6roA-d.:v~ S.Je-ff 3
City 1::::1A-6-I::7v'r Phone
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
C. I Tl:mpor~r~' Services or Feeders
Instauation'1. ~re~ or Relocation 'l.PIRE Ir irlE WOR"
200 Amps or .~~~~MIi Srl~\.\. ;\ \\~ ~~\Q.Qi I? NOi
201 Amps to tmmllED UNUtn. htl~\2D rOR .
401 Amps to ~ W.~NCED OR\~ "f. $100.00
Over 600 Amp~ \\N ~~ s~~\}J\,lM;ove.
D. I B'~~nch Circu-its To .
New Alteration or Extension Per Panel
One Circuit I
Each Additional Circuit or with '7
Service or Feeder Permit ~
$ 43.00
l(3
9
$ 3.00
E. I Miscellane~m'i~egciJrlr\aM'~~~.lj,n)jfjl~\i9lion I
. . f'nUnw rules adopteQ oy \I'" ~ set qElrt'
Pump or Imglll)llh t. Center Those rull1llHM n<>4-A~.
, . \l,."t a Ion h ...,.nAR .......-vv
Slgn/Outhn~L 52-:001-OO10t ro~~':llffU\J'e lulu';' t
Limited Enij e~tffl8y obtain COP_lajlt3.~ pOOR~
Limited Energy6~"<;\:IialC8nter. {Notue: t~~, l,'1,I~ifI~~'i~n
thA nre~on 1"1., t4b
Minimum Electric 1l~~~<;t!~lf!~h~!Y.!~.:l2~}larges
4.1 SUBTOTAL OF ABOVE I s; Z.
3blf
>5:Zo
bO <0'1
7% Slate Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding FormslElectrical Permit Application 1-03.doc