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HomeMy WebLinkAboutPermit Electrical 2003-9-2 , jecl as submitted has the toll owing s not require specific land use 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: ( ELECTRICAL PERMIT APPLICATION City Job Number eo"", 200 -;J-cJ-o '8]8 Date Date I '.;# C-~ lj-:l.-o3 'l<'LJ (0/1/03 f Signatu~e fsuperviscJing Electri~cian New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with ,IJJJ. 'A G- t"7'L., .....,."..,. Ser,,;eporFeederPennit Owners Name ''lAf'I1jt/W~ (Z.IN' rt""YltLr f fc-<L<O;'j '.', '.. . . Address a 70 ;\( ;;:>1.. /1 1/ LIE. I Miscellilileous (S~&i.I:#/"'..Jpr not.included) -EaCh.Installa;tionIK / (I<H'---.- /I v . .., ," U"iJ4'" "':-Mrr SHAll !:)l.t'lnt11l '7t1t:: \~ City ~Cs--bV(/ Phone PUIl1p or irrigation 1111S PER ZEti utm~~$j"W.'9q>ERMI1IS N01 Sign/Outline Lighting'\U:~OR~CH:' Oll ~~ M9.PJDONED FUrl Limited EnergYfReSileb)lalMio DHf PEP.lflSf5.00 Limited EnergYfCom~~a~ $ 45.00 l. l LOCATION OF INSTALLA710N -1o!c;~ ~ -A- /-z..-'3>'f C> 7'1 Cl a LEGAL DESCRIPTION {703 3,{; '1 Z JOB DESCRIPTION ~9-~ Permits are go-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. I CONTRACTOR INSTALl,ATIOfy- oNLy 1 Electrical Contractor ;l.;t{. . :-rP: lp- ~ , /t?C(Z-- 7~ ~ Address City 4~ Phone 7 z '1- f 5 00 Supervis.or License Number 9' Cf[;~ .5 Expiration Date ({)-f -D'-( 6"3/37 Constr. Contr. Number Expiration Date OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 8' - Z. !J ---c:, -:3 Authorized Signature 3. I CO~~PLl!,TE j,1!.E SCHEDULE BELOW A. I. New Re~identiaJ ~ Sillgle or' iVIulti-FamiIy 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 $106.00 $ 19.00 $50,00 B. t' ~eh:ices;;'~r Feed'ers!-:~lnstall~a,tion/~ltera'~ions -ot R~loca~ion: 'I 2.7YL rx> ---D '5 200 Amps or less tI $ 63.00 201 Amps to 400 Amps , $ 75.00 401 Amps to 600 Amps t: $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsNolts $315.00 Reconnect Only . ","s ~($-~~OO 'J'J 1""'- n Ijt\\I\~ ~~\a _,~"o \_... I . , ,''',"",,~.: ,,","'''''"'-'-' se,.J. e. . Teiupo~~I:X(~f[.Wces.llr..tllee~rs,.",oale __ ,,0'. :\\1::-\" (\u\,~'se\V" p,"''''''- po. ,<\.lIeS a. .o! ,\"10 ,."nOP' \.lIeS \. Installation, Alteration or Relocation 0\ \\"Ie I e \v""r-a.\\O\' - .. 001V'" nieS ,.,hOn 20Plginps or,le~.OO' - ,,\a.in cO,. ."" \el(No,.oO.ol"l ^ ~B. ';:1...... ...." au ....,Q\'='. _- ....\( L,hr,i::1\. 20l.:~ps t'!J~.oJl'Aii1ps tel. \\~ ..,,""'~ $69.00 nO 1...... ("',ef\ '('\ v...... ^., 401 ~ps to 600,'Afups' olego _~n_?'3...$100.00 Ca.III\ '''' ,\ < \\"Ie 9.0\1''''''-- Over 60Ql,w.pS\orqO~QOJ~.o1ibee 'B" above, D. I. ,8rancil~ Circ~~rtf?'~,:,;~', , ?' " j I ... I $ 43.00 $ 3,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.I:s~rC!T#PtAB6VE :.: I 3Zr Z? 3'7 -:3Z'o ~;;S2S"r 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)!Building FormslElectrical Pennit Application 1-03.doc