HomeMy WebLinkAboutPermit Electrical 2003-6-1
0, CITY OF ~ )rnGFIELD, OREGON. (J
," I . d h s the following
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . ~~6\1\M.~b7~8Q sUb,mltte "tiC 'and use
ELECTRICAL PERMIT APPLICATION zo~ing. and does not requl~ s:c1
I , "'rY2 k."~ approval. ~' ,
City Job Number (.1)YYl'JoO~-V'""JlVme , ,Z 'ng- , ,~
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i. I LOCATlONOFINSTALLATION 3. I COMPLETE~8eJ.r~:UlJL.ii&I,-OW '_~ '
! 77 '().~ A . AUthorized SignaIU'"-"
I
LEGAL DESCRIPTION
i E'<,~~<.""'" '?N;\\;""
iJOB DESCRIPTION '
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: FI-e.d~~GA.\ 'L"'5~.Jl...L#J ~eJLt,".J..,
A. I, NcwResidentlal~ Slngl"or l\1ulti-Fnnlily per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$ 106.00
$ 19.00
Ipermits are non-transferable and expire if work is Each Manufact'd Home or
jnot started within 180 days of Issuance or if work is Modular Dwelling Service or
ISuspended for 180 days. Feeder
A-r'IJ-I\11 It "" .
:2. I,CONI:R4CTpR INSTALLAn(jNO~Y,.1 B. Lsen:ice.~iQr"F~&.~~ifM~~~~'i'lftJWl~~~~bcation:.. I
M vJ ~ -/ "h. T.I I~OllTlCatlon Center. Th~s€(rt~' ~ ^ - "I. (, :r, 00
Electrical Contractor E );) 8-// ~vr. 200 AinpSicirl1e~s52.001_001O t"" ! '$r63100t fort -
I ro,.. ... IIVUl::I I vAC gC:"-UU1
'"P 201 AiripSlto 4OQIff.rr\Pl'I obtain C--" . $ 75,00
I '" 12.0N' ....., SO? I ....,........."" VI tho p',dQS 0
'Address ,u, IJ v," L-'''' 401 AmpS'tliI60g"'IIlP~enter (N-'-"~' ,$125.00' .
nl t ( . -..... ....... ~eleohone
I 601 AmpsliD' roOO'Jillipsl Oregor> IltHi+,. Al $J63,P8
I q-:j ir ''- ell J) ( 01 r::. ~ uflflca ILl!
ICity ~bF.oIJ1& Phone i.J"1 PMP-Zj{,5 OverI000AmpsN611s1rIS1-800_"l"l?_"'>1Jf75.O
Reconnect Only $ 50.00
,
I Supervisor License Number
I
: Expiration Date
I
,
I Constr. Contr. Number
3ZJ'Z.- 5
/Q-/-oc.j
;2() - 1C/5 c
; Expiration Date
/11-1-6,
; Signaru:7~ian
V/ 4
: Owners Name Gre..~/ (l0.hnp4h
770 5/), A
City -4Ji-f d Phone q I 0-. ~ 1lJ.4
, Address
OVVNERINSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request:
72:3~~c:-..\\)<tCf:, (\~
~ -~ \9'JJ
$50.00
c. I 'tfl~iporary"SeI:vices'oi-'J!eed~rs> .'
I
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
40 I Amps to 600 Amps $100.00
N~& Amps or 1000 Volts see "B" above.
'W~Jii6MIi:~l exPIRE IF THe lA/OR'!
~~rm#.~~~Q~iJtIISJlIiftWJtje'NOT
AN9~ i'J.~ R IS ABANDONED FOR $ 43.00
I:a~ll aM~!i./ijQdA;t or WIth /'2-
Service or Feeder Permit $ 3,00
h ~b 2il
E.I ~'li~ellaiieo';"(Se~i~ejf;ed~f nlit'lntluded) -Ea'cil Installntio~ I
Pump or irrigation $ 50,00
Sign/Outline Lighting I $ 50.00 B 50.'2
Limited Energy/Residential $ 25,00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.1$U1JTOT)fi.O'F~OvE
'I 1/ 1- f ~
# 10 t3
-LL4 '1.!..
:I /74- 33
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding FormslElectrical Permit Application 1-03.doc