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HomeMy WebLinkAboutPermit Electrical 2004-1-9 ., I I . ",_.' o CITY OF SLJNGFIELD, OREGON > ,. '--' 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 c.<!.. l-q-04' -.. 'flt0 I. I LOCATION OF INSTALLA110N IIhb S A ~+ 6b60 z. LEGAL DESCRIPTION /703.-;3 5Lf I JOB DESCRrPTION -A~e, L{ C ll2.L.v\ 1t-" 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 \51.o8-S I b-\ -()~ Constr. Contr. Number SL\ Ll3 \ Expiration Date q - ~Or 04 Supervisor License Number Expiration Date Signature of Supervising Electrician ~~~.~ 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