HomeMy WebLinkAboutPermit Electrical 2003-9-2 (2)
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, CITY OF SLdNGFIELD, OREGON C): :' ,.: '
jecl as submitted has the tollowing
5 not require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (5'./'1)726-3689 I W C-(!
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ELECTRICAL PERMIT APPLICATION .. Date lj-:;" -0.3
City Job NumberCo""'20o-;J-O-o '838 Date g-Z-tf'-o3 _/. I
Authorized Signature '1\ lA..J
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
,uA. 'A G- 1'71... ~" S=ice-or Feeder Pennit
Owners Name I'lAl'tftllWrr(LIN ~Yl'L( IICAL'>,., , ". .
Address 770 /If P..6-r1..~ )V E,I MiSceIlaneolis,<s'93~~rriotinclUded)-EaChlll!tapa~K
. MIT SHAll !:l\1"1t'\E1f III~ ~
City ~Cs-bVr..r Phone Pump or inigation THIS PER ZEe ~tmtqsrf\\-9qJERMIT IS NOT
Sign/Outline Lighting\U:HOR~Ca; 3['\ \g M9.PSDONEO FUK
Limited EnergYfReSi~I~IM~O OP-V PtRIQ[,f5,00
Limited EnergY/Com~~a1 $ 45.00
I. I LOCATION OF INSTALLATI01'! -
~!C;~ ~-A-
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071-( G a
LEGAL DESCRIPTION
/'70S3bL( Z
JOB DESCRIPTION
~9-- ~~
Permits are .4n~transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
2. I CdNTRACTORINSTALLAi'IOJyO~yl
Electrical Contractor ~p... ~7, .',
p
loC(z- 7~ ~
Address
City
~.........o.v--<--
cI
Phone
7 Z-C(-(5=
Supervis.or License Number
9 c(I:~ s
Expiration Date
16-( -D'-{
65/:5 7
Constr. Contr. Number
10(11c,!,
I
Signar;;;zisZ;IeCtri~
I
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
"i
I
3. I COMPLETE'fEE SCHEDULE BELOW
A, I.New Re~idential-Singl.e or Multi-Family per dwelling nnit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
. portion thereof
Each Manufac!' d Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19.00
$50,00
B. 1,'~t?t,;ices,jor:F~ede~s ~:~ns.t~ll~t~,~n,.~I,terat~o,ns 01' Relocatit:~n: 'I
2.7:fL~
n<5
----<.
200 Amps or less rJ $ 63.00
201 Amps to 400 Amps I $ 75.00
401 Amps to 600 Amps 'If $125,00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts $315.00
R.connect Only . ..,,,,S '/($-~~OO
~ t"''''- \.I\I\\\~
-~\::I. __,,')01'1 I_A
C. I TeIUPor~.;x\~~b<i1W~,:f~dt~ ::;~ ~{e se~ ;:~ ,
p..\I 1;:.1 leS a,OU\' ,\"lOSe \ ,- Op..f\ \:P" - S \.
InstaIlatiori~Alterati~iltor ReloclitiO'ri 0\ \\"Ie tllle e
,v""ra,\10\'-O~_001V" nieS I,.-,non
2091~mps or_le~.O U\a,in CO... ....0 \e ($~~O,,~O\On
"",~"... _" 0 ~IO\tl,.- ~\('\~r,'
20I.?illips t9jtPSl'Amps \et, ~\~ ....,.,,,, I~ $ 09,00
401 ~p~ to 600,'Afup~n Otegon '::'~';'_?3t\$)00,00
<;a,\\11 ''''. \ ,\\"Ie 9.0\l.Jv-
Over 60Q,.:'.IUPSlor1090oM.Qltbee 'B" above.
D. l. Bran~il CircuriS~l'"
$ 43.00
$ 3,00
MInimum Electric Permit Inspection Fee is $45.00 + Surcharges
4,ISVBT~T#OF ~OvE
I
:3Zr
275''7
'32-,0
~'iJZS"r
7% State Surcharge
1 0% Administrative Fee
TOTAL
Shared Drive{T:)/Building FormslElectrical Permit Application l-03.doc