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HomeMy WebLinkAboutPermit Electrical 2004-2-24 (4) ,,,.: " 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726.3753 . FAXf"J:MW%i!!iI/&tassUbmitledhasthetollowing ELECTRICAL PERAIIT APPLICATION zoning, and does not require specific land use City Job Number (O~ 2.Q) 6,~OCb \l Date 0'2 - 'Z..l\, -0 4-- approvaiz'. !A...,{:C _ om09 1. LOCATU:!N OF}NSTALI:4'IJON';' 3.COMPLETf f~~o~~:i~n~}:"-:0'H '.?~~j- Supervisor License Number cfl6 P-O.;:;.<li). ~- R>' /70 'I,'\Y:-\ f.> ;: Installation, Alteration or Relocation (. ,. ~",. ~,. ,0 ~V~"'.. <<:: 200 Amps or less _" .., $ 50.00 Constr. Contr. Number /vi?'7.. ~ 20 I Amps to 400 Amps n<O ....-, \.;s.'~;"\$ 69.00 'v ~,\. ~\(,J '!o.' ~"- ~ ~ ~v . 40 I Amps to 600 Amps o..~~..,O <-0 ('0:$'100.00 E D c...'0~,;'~ I 0..''''''"/ .,,0 {"'\,0'_<0 ,c"" \ xpiration ate..~.. ....~.-.J(::.~~"J~ Over 600 Amps or 1000>Vol~'see~B'"ap~ove..\0''' n. ,~....,~. "R:-' <;jv' . '.",. . .~' ~ ~0 '~. . ,v .~v' ,. Signature n~Ro~'B~' _f:'"i~~ D. Branch Circui~O '0'\ 0 ,oS ~O ''$'0 ~O '0'" '. ' ~~~f.> ." :\<< ' '" ,0,<0.06 ,^O'" ,,<'$ 0.... ~0<<~,(jvs- . :". ('o~~ New Alteratilm"qr,Ex!i:nsion':Per<Pawl. O~ >\' ",,& . -<\v 'lJ.v~ 0" C~. 0<<' ~ ~ " '''''~' ~:' ___ One 9~i11~0"'" ,,<:::-'1: ",C" ',<,\ G ,~. ~~-.\ ,~~ ts,4,,00 v~.~ E~If.J;dd}lib~,a!J9;~ulS8(<wl~~0 \$~:".,!!f" /)D <7'" f!! L Serv.'IC~r'Feec;1er~ernfit 0" ,,0'" ::!",,'j $ ,.00 .., ~ ... "" VA. Q.."""'" -0' . r~' b" ",,'lJ.~ f:o'l. ,0'" <:Y .;>r.A--"~'~ '~''?t'''''__ ,.;- '*-'\\"..<<- q;. :I)" (,0 0', ';:/" '. . .. Address,.;zst:t::l ^A.A-I~) C -,-.. E. . l\"l!~llln.ws (~.f.'viJ:Jlfeed'er not included) -Each Installation '7 L .. "'",cq;C.~,,,,CfJ:,,o':.r":' ......, ., '., , City {;;,(Z, ,V&AELf) Phone 7 L/ 0 - 'h Ll./ f Pump or irrlg'll'~~ r' $ 50.00 · SignlOutline<t1ghting $ 50.00 OWNER INSTALLATION Limited EnergylResidential $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 IS not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges IDl~ ~ ~ ~ W 151'1' 0<"> Owners Sicrnature: n\ 4. SUBTOTAL OF ABOVE 15.3 - FEB 1 9 2004 7% State Surcharge /07.2. 10% Administrative Fee /.C; 3..9- ,-{OSeOI-I(j VI,1. Ln. /7CJ_O/ TOTAL ;;;'0:<7 50. JJ <;;, LEGAL DESCRIPTION /7033" L{ :<0 73D6 JOB DESCRIPTION n!=F, Lr. !-<UIU")/lJt<- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ~ -:"'''''''(:'.'_1, ;'_ ", "" '1-, \, .-"" '."<- -, '''''';-, ": 2. .C,ONTRACT()Ro/STALLATION ONLY c~ <,.., . _ . _ .:...,_.',j.. . _ _ . Electrical Contractor ~//1 olcIJ C/~d ..t~, Address J?/ 7-;- u/. J4 ~ City ~~ Phone 3<13-72-97 Expiration Date Inspection Request: 726.3769 " :,' "!' '. - ',' ~ - 'J" .~", "l. " --', -. .' ~.. ',' :^_.' "_," " A. ; Ne"', Resi~~htial-':' Siitgle, ~~ Multi-Fa~niiy per d\vClii~g .u~itr i'."lI.,f . ....'.>_", i~:""-"'_~",_,",,,\-,,,' .._...,:',N~t,',~j; '1- '1 , -:,',- ,.P'.' ..., ~i Service included 1000 sq, ft. or less Each additional 500 sq, ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or F ceder $106,00 $ 19.00 $50.00 It' ,,'" .' -_~'i;o?: ~: . '\: .,' "-"""'; .~ "-,~' '" :~ ~ .-. ,'M B. Services' or.Feeders.;, Installation, Alterations or Relocation:'" ~" .:.",,':t,L-/_'~~'.,~."..,'.:-".',:::' ,'-::." ,.-,,>,',_::C..\'> <.-: !;-',' _:,-_''-'''-, 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to I 000 Amps Over 1000 AmpslV olls RecOlmect Only / 3 0'" fa - $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. '---:;'..,.-'",:".~ ~_,~..,-,4i:"- '__-' ". . 'j- ':'~. ...... TemporaIj"Se-rvic'es or Feed'ers,\.:- < ~."_.' . ,_..... '.",:". , . -'..' ~.~. . , --::'.1 -.. ~ ,v j___ Slwn.:d Driv.:(T:)IBuiIJing FOll11sJElr.'Ctrical P\.'ll11it Applicalion 1.03.00C