HomeMy WebLinkAboutPermit Electrical 2005-11-15 (3)
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SPR,'NJI.jlsj P'5
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 :'.':;':'})Y...'1.. .D" '01./ ...
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ELECTRlCALl'1}RMIT APPLICATION n '---IM~ ,,0/
City lob Number COJ'\lt~OS- D/C~/Z- Date Lllt~ IOs .; "':':'~i .-0
I. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days ofissuance or if work is
Suspended for 180 days,
. CONTRACTOR INSTALLA1.10N ONLY
2.
Address
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Electrical Contractor
City
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Phone c:;Lf' 2g,j 7-
Supervisor License Number ~';(.<, X'd L. GA.
Expiration Date
/1) - /- 2cn9
Constr. Conlf. Number / L.,"6-;";/K
Expiration Date :?~ $5'- ZOO i-
Signature of Supervising Electrician
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Owners Name .:?,~Mf.--w,r.
Address pO. "Bar 2D
City.5pYi~ Phone
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
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3. COMPLETE FEE SCHEDULE BELOW,
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A. New ~es~denti~I:- ~i,ng]~~ot ~1ulti.-F.~~,~I~~.p~! ~~e~!i.~~. uni~;.. _
Service Included
$106.00
1000 sq. ft. or less
N O""p additional 500 sq. ft. or
THi}H'G&ereof
AU~~~1It1i<$~AI?f'J;fA
COMMfN ~&qJiq~f~THI ~RE IF THE W1JftK'i50.00
ANY 1 0 CEO OR IS AB S PERMIT IS NOT' " .
B. e~nQ~Y cf?8RfGU: -~Qg~F~lfrations or Rel~cati~'1:
$ 19.00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
. -. -. "', ~ . --....., . ^:' ., . . .
. C. ' Tenlporary Ser:dces or Feeders
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Installation, Alteration or Relocation
200 Amps or less $ 50.00
ATTE~91~NP~t~ 400,~mps $ 69.00
follow 401 t';mps.tu.600 ,o;mpSreqlJi'"s $100.00
'. ruJeB adopterJ h,. "-, ~ -, /"U:rJ
.l\JotlffcatQY~rJ;gA~p'Pf fI~.1 Ooo'Yoltnee ."1;3'". a~?ve,
In OAFD?S;.Branch,Circuitsse: rl' as ;r,: ':" R'"
009 ,: YV""tFj*Jtl1rooiiJ' () ,_.h:, '._-,
O.YoNm"AI""" E' .Ap p. 'I
II' ewe teratlon ou xtenslOn er ane
ca Ing ~h ~ , ... 1'-",.:.) UI ")-1 ,"
no b qn~Gircuitr. (Nolo: I':' .' $ 43.00
m erEachtAdditi'!.nJLb~i[511i!?i ~with
<Service or Feeder Permit ." $ 3.00
'. . UVU',jv<:::::_' ~
~u-'.-+).-
E. . Miscella~eous (Serv~ce!~~eder not included) -Each Installation'
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
X $45.00 4:c;'.OD
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
,..
46.00
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4- .e;CL
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4. .' SUBTOTAL OF ABOVE
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Forms/Electrical Penl1it Application I-D3.doc