HomeMy WebLinkAboutPermit Electrical 2007-2-5
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NM
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH;(541)726-3753 . FAX; (541)726-3689
ELECTRlC# PERMIT APPLICATION
City Job Numberel" - aoOt 0)" Date a 15/ 'do (JUf
L filOCATIONIJF"1Nsr;/w!tfroN1i'~2}flJ..\ffi'
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LEGAL DESCRIPTION
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JOB DESCRIPTION"
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not started within 180 days of Issuance or If work is
Suspended for 180 days.'
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3. %'COMP]]ETE'FEE'SCHEDULEBELOW,'''''f>>~~;''i:''''''-i'~:~'
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,,_A~.n)i1I.~~'1$j;\*,I(,,:tr4~___o.....,.\;j,:'lr",(,''';'i!.'t'::~;:,;(:''I'_~"0.;~P....~~~'.'~~..;i,>-'/t~
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
$106,00
$ 19.00
$50.00
'fif?o7liRA'&i&R~JNSTY(fl!!l:f1(jN:""5"'f!i:,'fJfi B. ~~t~~'@~~tt'i"X&i'iHllimrifmli'h11;e;:?~J~~-;:'k'j(~;~'Liri'li;:~~
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Electrical Contractorr /If -".on Eler InC.. J/J(l. 200 Amp"No~ation Center. Tho e rU1~~9~$
f) . 201 AmPSi~E!J)QfA.Rlii2-001-001v [ln~\l'.$dftll~ r,.I,,~ h,
Address rlOI f!.~ il7 401AmpsOO9ID,AlapkmaYObtal1iitr~t~~Jidloo...~nn..-
_ _ ~~U',..n tho 000101 0 6. n "'f'
J ' ' 60 I Amps to ~ooulronp'\;' tnQ ~~~ '_'t;\M(jill9lllication
City fl(l/J(f/1 (1i(!j Phones<ll-998-58/8 Over 1000 AR,,\l~fm ---is 1-8~-1'!l?S2~9,
Reconnect Only- . -"Oe",,,. $ 50.00
Supervisor License Number (q ~ ;2.J...CS
16/I/JUj07
(/JLJ:5 200 Amps or less $ 50.00
Constr,Contr. Number~_;;?J..-?<-/(I, 9>5/'07 201 Amps to 400 Amps $ 69.00
_ I; j . I. J. /. 401 Amps to 600 Amps - $100,00
Expiration Date 7 / ~ / 2~ '/ '&J/ J(J::x)7 Over 600 Am~ g;rI!&~ V olts se~ "B" above,
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N~:::;~:1iJ[jiJl~it~~':""~JHi'~-'PE~ffiS1ltff~<'~
~:;: 1:::> .:2~./f '::7_ One Circuit COMMENCED OR IS ABANl:$ON~ FOR
EachAddition\~ir18GJt~tii'EHIUU'7 $ '.00 ...../ ao
Service or Feeder Pennit -' 0'- .
Owners Name~L- l~ Qjrz.- ...""_"".~","",".._.,,,,,,,,,,-,,,-,,,,,,,,e<'-_.,,..~,,_.=.,,,,,,,-_-'_"~C""~-
Address~ "') Co ~. rf1a~ E.ftmif;lirli~~~~;&!alc~(/:(i{ii~ii~~J~;~l~t~~;-l~~lJ{\i~b_ri~
ci0 YJ;Q./ Phone 4g"5 -0'3>40 Pump or irrigation $ 50.00
(;if 0 I ~.,. Sign/Outline Lighting $ 50.00 .
OWNER ALLATION . " LimitedEnergy/Residential $ 25,00.
Limited Energy/Commercial $ 45.00
Expiration Date
Signature of Supervising Electrician
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request; 726-3769
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Installation, Alteration or Relocation
Minimnm Electric Permit Inspection Fee is $45,00 + Surcharges
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4, .,SUBTOTALkQ.F,JAB, og.EJil,:~i;,J'* :it~c;j,JV,~:,t,~#,l~l"',"'ly~
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4. f% State Surcharge
10% Administrative Fee
<G'"Io l' ~ R.f...
TOTAL
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Shared Drive(T:)/Building Fonns/Electricnl Permit ApplicJtion I.03.doc