HomeMy WebLinkAboutPermit Electrical 2005-4-1
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2;:5 UJ' In STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECT1UCALP~ APPliCATION . ' ,,),' ",
City Job Number (l.c')~':2.C)(YY'::"C/;.s.-:.tP' ,..Date . y-/",~..." < ,. '.., ,.'
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"f;;~~/":7300 ,"~~'" .~
JOB DESCRlPTION 1000 sq. ft. or less ,r' $'i'~QQ'.
_ Each additional 500 sq. ft. .or "( '~~"O''o?<
;(J6-'7J~, €/t!'r7i:Jn& .;(}A:r.Uj portion thereof "f>l'l 19.oo~",:",..;.
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. Permits are non-transferable and expire if work is Each Manufact'd Home or
" not started within ~80 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days., Feeder $ 00.
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2 ,eON!FRif.e:rem-TM,," . ' <TIO'&O . .' B. s~ces-;<ir;i;~l1eis':" i1st:iUation;'?ro,r~ratiO~;'$JP;lo~nOn:
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ElectricalContractor~I'''''.l1'''..t1 Elh 7;(}<..,
Address ~'if'''t s... A / s...;:-
City.~
Phone
7,2 (., - (.J?.s-R'
.
200 Amps or less / $ 63.00
201 Ampsto400b,mps. ,',J;' " '''$75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
A~~llW~YCUto $375.00
~it%W'V/lIiI~ by-h O~ UtIlItY $ 50.00 .
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clllfItfg~tef.ll{\lloIm:lU1lil~O~;. ,
llI~~regon Utility NotiflcatlOli$ 50.00
201 ~l1a~~d' ,.... . ,$,69.00.
401 Amps to 600 Amps ' $100.00
Over 600 Amps or 1000 Volts see UB" above.
D.~~Gt~~~~~~~~~
New Alleration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
b3
Supervisor License NwDber '--'3..;> s (.., S
Expiration Date
/0 - 0/- fl7
Constr. Contr. Number
/. ~.R'\ /J'f'
Expiration Date
.;2 - ,;) St - r"c..
Signj!ture of Supervising Electrician
1_~k.JlJ u.dn. ~
$ 43.00
$ 3.00
Owners Name t-t IA-v..,/ f. I~:r(.:, L:')tt')r-
./ --;- .,
~3 5".":;' :::r.Jt2L AJ..O A/V&(
, J r.;
Phone 5/7- "7; 710
E. ...~~~([~elf~l'tfn4itfu..fi!lfrJ~~~~m.~<>.-'
. ,HI PERMIT SHALL" ,
Pum,p.I9~!W.~~,oe'D U eXPIRE IF THf$'SO:OOK
Signl0utline:1ig4ting NDER TH/" r'tHMIT SfsO,OOT
-...."L"vCU OR I~ ABA" . ,-
LimitWiE . ,IRe idential "UUNED F$l2'5.oo
l'~(JAf rCt110n
Limited Energy/Commerciaf' $ 45.00
Address
City J:'j"',,(hl
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent '
Owners Signature:
Minimum Electric Permit Inspection Fee is S45,OO + Surcharges
4. ~wmrf~EABO ,. b-:$
e;~~~~~'I;;~:i~d
4 '{ (
7% State Surcharge
10% Administrative Fee
L-. ~o
7~7(
Inspection Request: 726-3769
TOTAL
. Shared Drive(T:YBuilding FonnslElecnical Permit Application l-QJ.doc