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
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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
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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