Loading...
HomeMy WebLinkAboutPermit Electrical 2004-10-15 . '" .1" , " " . I' ~i~' "'''''Il.,. . ~l'gr it~ I ' ;:P...NOFJ....D:. 2251'J.J:'Il:1STREET e SPRINGFIELD, OR 97477 e PH:~541)726~3753 eFAX:(S41)726-3689 ~~ ELECTRICAL PERMIT APPLICATION . . / ) " ~,. CityJobNumberCO"",lPCl.\ ~ 0 1'Z-~ 7' Date 10 / c; 0 f : .' .,..' . I'''''. '. 1. F::lOG'A"TIONJOE~iNsfAl}iJAfidM;>!!-_ 3. [c:gMtr;;a~~tg~iBEiOTAA~~ }7'1' ~~'s'.'l~"Sf-"-"'!(~'- "'." -' .. , '-'~'~-"':~;t~,,,~Al " JJ _ _ _ . " ()" a: "'0' LEGAL DESCRIPTION A. 1i!"~~.\m1t.;'s' eio,' uirl'f(~~~~~~ ~,_,. - *,1l,:,';.J"~;"'J J 703"3 53l _ _ '- ~.Zcro Service Included -"'>,,0' & ~~.>., ''''''':"'''''':',, . (9, /.... ~A~' JOB DESCRIPTION 1000 sq. ft. or less . -"~1. "", )'1'1:\?!!"'t . ..::=; trtif ''-- &t+r; ,,(;.- Eachadditional500sq.ft.or "'" ~ . '~~'&-'ol. Permits are non-transferable and expire if work is Each Manufact'd Home or ~ ,....,u~..::,. '" ..~ .,",~~:. flll'!~E: :"t:""""''lIiRK ,~, ~""" ";''". . Suspendedfor 180days. . .. .' ..... 1 IS PERMli ~er .IS PERM\i_~ Noi .. .' . . 2 ~NfRAffi'~,'iNSfATffiI.'TIONr' i R\IEo..~ik~Jll~~i~t<Yti)'fIr:tiJfA'!!AJ1Wft~. o~m,-~~il . ". "',,-'...... ,.... . ,..'., ,,8'lCEll~r~-"'''~''"''''if~b',"''<'''''''''''''''-'~~?-~ .', Electrical Contractor Lci...rE ~ ~OJl..'( fo% Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 Address PO. !b~'>t II ( '3 q 401 Amps to 600 Amps $125.00 , ., b ffJ - s-q q (,,;, 601 Amps to 1000 Amps $163.00 City P;z; b t:;;7Uf3'. Phone . Over 1000 AmpsIVolts $375.00 Reconnect Only $ 50.00 Supervisor License Number ~ <:; 5 3 5 10/07' ~ u 200 Amps orless 'a"'''' $ 50.00 . ==::~;~O !~~~. a /.u' .\l\OI>o:~m:L'/iLlb ~ ~~W , I~ 7f. (Cd TfA/ 009~~tce~~e:.o.l\Ut\\\tyN~ $43.00-" ~ --- V CAA<ih~cfdI!i~ 'C. ~~ - . . l\l:;,mcecgf)~\!&~~1ermit $ 3.00 Owners Name Las... ~-kL Swo.=a Y' t- . . '. ". Address j ,,'- "'. ~ _-'-'- l'^ II _.... ...... E. ~.:Mls"f'ffili~6iTh1(s"'frtl~lilld~~tiffiEiif~d)~tt.111~triij;'if'~ .....,.. -.. ~ ~ _ r i!:E'-~""~"!::"'~-'~W""';~"""~"'-.tt:"~"',~-","",!<",-:>;,,,"~,,,,,,,,,,,,,,,,"'t:::.'-'""'-~,~.""" . ~"'JOiM~j;-~LY..'X.;:~t"~'r.;!i.)_~"~~.-.' ':':"'Ci,c.;.;~~",a~~r~" - :~~ C.emp'orar,v,ser.vIces:o~FeeQer '"~ f\(~~;;1,~'~", . ",-. , ~.....;;..:-........">'''~'''.l'-'.''----''"'I!I:Q;..., 4' , .. - dW')--~"'" ."_ ',~,_o Expiration Date . Installation, Alteration or Relocation City ~..l Phone _t-.r> I-. /-.,11.0 Pump or irrigation $ 50,00 /SignlOutiine Lighting / $ 50.00 Limited EnergylResidential $ 25,00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~-l,~'l':f>.'~r-:t~~::.~~..:..o. ?fr-e~'-':::'~-"<"'~~III' :'~ '~~"~- 4.,<SUIJTOTAE:.DFAlJOVEi;t ~"""'" . -C--(;::) ~~~~~~~,~~h;.:~,,~...;"'~.t'it:t".:1Y'-" '?:;~~-- ., --So - -=> ~ 7% State Surcharge ::> ~ 10% Administrative Fee r.::rO 58 ()'U ~ OWNER INST ALLA nON The installation is being made on property I own which is not en d for sale, lease or rent. o -, Inspection Request: 726-3769 TOTAL Shared Orivc:rr:)lBuildin~ FonnslElectrical Pennit Applic:u.ion 1-03.doc