HomeMy WebLinkAboutPermit Electrical 2005-2-16
. . . I .. . ,>, SPRINOFIELD.
",,,-:5"JL~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541')726-3753 . FAX: (541)~6-368%:~ J'~-i~ ~
ELECTRICAL PERMIT APPLICATION -Y", ".., ,,/" V' t.;,
City Job Number CO",^ ZOO'-{ - 0 I :) bb Date ::1 .. / t:.. - <"J z:- ~O~. \ ~." '&";9-,,
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I. I LOCATIONOFINSTALIATION 3. I COMPLETEFEESCHE~BJ!:t"Ow'~,,;~
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LEGAL DESCRIPTION A, I New Re~identia' c.'Singleior Muff -Fa . e~ d';~iIg unit.
" 7 0 -:z -3,1 < I 0 -, -. 00 ' .~ ...~
.::> b':> f .;J Service Iocluded "0' o'*::
JOB DESCRIPTION 1000 sq. ft. or less ~~o~'"
Each additional 500 sq. ft. or ,,;.
/AJll=~ '1>~ ~,....,4l~"/ ",0 portion thereof
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
2. I CONTRACTOR INSTALLATION ONLY I B, ,. Services ~~~~~-tl1l'talia;ion, Alterations or Relocation:
fl _). ~~'Il {ES 1~I~P" ~ \0(\)'\
Electrical Contractor \ 'of ;(J (1J UA.J ~ E/ ~~!;JI\~QrGl1ss ~,e SEl 2s:P'" $ 63.00
i'i\o~" o~~ttl-l\\l~~ ~e'O '0'3 $ 75.00
Address ?l'o)?9 .s,., 'A.... S-T..~~~.\}\e",~6\\\~QJ~~~'aOo\~~\\0(\G $125:00
'O\\O~ ~O\\ (j~\6dl>~~~~e\'li\~~ ~ $163.00
7..2' ~~'2.-(l ~j::o'a}~W<t~~~'fIl\~~ $375.00
\\\ 'lO\) '" '~ne~6lu~'L-~ $ 50.00
Cr;:f~()'. Q,\\\e ..O,e ~
~\\('i. W,r;,:.oC ".' ,
Supervisor License Number ~'? 1St.. . ') ",~",'Oe' ~'!'liiporary Services or Feeders
City ~...<ZL'" .r;., 4JPhone
Expiration Date /0 - C I.. C "'7
Constr. Contr. Number
/S" Ii> J?c::.. -stJ
Expiration Date
-::l-.2 1'/- ('") Co
Signature of Supervising Electrician
A~fl;J W. L~ ~
Owners Name i.<M~hJ.o IM.T~~
Address L("3)f" 5 t>tt.<IlI~ v5.t....!}",
City t::lA- tr-is,v~ Phone _")7- '?~
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Installation, Alteration or Relocation
200 Amps or less
.20 I Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. t.:;B~~~f;h:.'tlrc:4i~:~:' :,', ":.'i;,I~! "';':;,,':1 "r ;"r>\I.t~:
'-l~0'
New Alteration or Extension P\~ P,alfel S Ii\(J\
One Circuit ~i-?\~~ ~Q1-l\\'Y'-<;\ $ 43.00 4.3. ()O
Each.Atldition*,<;'i'rcJit orfitb? 'Ii\'t.Q,.,,\'\)'
..\S~c'e"onEe'&!er pemii't. \ '~~ID(J'y $ 3.00 ~:? lTO
\'~ oC\'\'" ,1\"lV' ,~t"I"
f'c ~\.. A<\\ \) ,e. t"
d'-n {'\ ~\c.....:' !' \...
E~ \IW,'cella~\"!,'!~(S;~#eeder not included) -Each Installation I
.. 'I!IW\"\' \>-'i {~
P~ or itBga'i<on $ 50.00
Si~~~tline Lighting $ 50.00
Limited EnergylResidential ' $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
$ 50.00
$ 69.00
$100.00
4.1 SllpTOTALOPA'BoVk' .,1',.
'1
;76.aD
470
7% State Surcharge
10% Administrative Fee
00
'I
'1;/~.
TOTAL
Shared Drive(T:)IBuilding FormslElectrical Permit Application I.03.doc