HomeMy WebLinkAboutPermit Electrical 2005-7-15
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726"3753 . FAX: (54I)726-36~~~":,,;,'0 ~ ' .
ELECTRICAL PERMIT APPLICATION ,<,6\0C> ,0, .
City Job Number COvV\'L()O<;"- 00 I'ZJ D!/.ti'''~S~t-15 - S _:",,{) ,
I. LOCATION OF INSTALLATION 3. COMPLETE Fi';;~~~L'{' V \'WY\
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A. New Residential- Si'il~le~''t1ulti-Famlly per dwelling unit.
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Service Included
-. 0 CITY OF S:)INGfIELD, OREGON ()
II 't t .4 ST <::'~I~flfL.D I)e.. '1741-1-
LEGALDESCRIPTlON /70sT:::,-<{( OJ boo
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JOB DESCRIPTION
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1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50.00
2.
CONTRACTOR INSTALLATION ONLY
B. Services or Feeders - Installation, Alterations or Relocation:
Electrical Contractor
/
/
/
/Phone
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpslV olts
Reconnect Only
f
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
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Address
City
. /'
Supervisor License,N'umber c. Ttm~~~i). Services or Feeders
/ ~'C. \t ~~.,. Ie; ~Ci'i, .
Expiration Date .. \ I c'f..'i'~ ocIn~tall,flion, Alterahon or Relocahon
/' - . ,"- Sf V" t\)'(\
/ ~\)'\\J"'~*,\"i ';)"D'C.~ "i\\\ ~\)G(l6.'Amps or less
constr.,(~ontr. Number .,-\-\\'2> 1'1;:~'11'\) \J~ ~ ,e; 1>-\)~ 201 Amps to 400 Amps
/ '1>-\J"i\\\JI'~\:,'C.\) \J' 'i\()\) , 401 Amps to 600 Amps.
EW1ration Date ("{\**,I;: _ "t>,'l 1'1;:
; v :{ '\ '()" _ Over 600 Amps or I 000 V oils see "B" above.
Signature of Supervising Electricial}~ D, Branch Circuits
New Alteration or Extension Pij\"tIJ';JItAU ~~
One Circuit Ot\ \~ t~t""ot\ \.I~I ~')~3.00
Each A<llli'iw.~:!!~ ~ S a.te S'=". ~\;
0/ S " _ '-, ($.~t~~~~\\Ose ~~ of'~ q~~s 'o~00 -
A \O\\~ ':" cel\\8' ~l~tOIl'" ~ \"e e
tr ':::, T E....in~~li\\\e~'/)"\~,,\cel!~i~ 1?0\l!I~~l'fach Installation
Q . ' "a opS\ 952 a~ o'o\e:t\ ~o\e'. ~~e ~o\i\ica\1
Phone l ':>'"3- Lf '77'/ ~Gr~mo't;e,,\et. ~ 0" \.I\I\\\'! A b.). $ 50.00
si2n;~~~p~?t~%QQ_~~'2.-t:' ' $ 50.00
Limitf/ll~~~'i\l1al $ 25.00
Limited Energy/Commercial $ 45.00
$ 50.00
$ 69.00
$100,00
Owners Name 5<:-0 II
Address
/f77
City C =? t~.r-...
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit lnspection Fee is $45.00 + Surcharges
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7% State Surcharge
10% Administrative Fee
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4. SUBTOTAL OF ABOVE
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)JBuilding FonnsJElectrical Pennit Application I-03.doc