HomeMy WebLinkAboutPermit Electrical 2004-2-24 (5)
. 225 ;llln STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAXi:M
ELECTRICAL PERMIT APPUCATION approval.
. Zoning
Cl!yJobNumber (biM'200q-OOO 17 Date 0"'2. I '7 0 'f
1. i~!:Q~~t19~ljff~.v~.1?~
20'2-7 s. A st
LEGAL DESCRIPTION
/703 <:. (.,LfZ 07 3DO
JOB DESCRIPTION
TCW' f' ?Ow'c-<L-
Permits are non-transferable and expire if work is
not sCarted within 180 days or issuance or if work is
Suspended for 180 days.
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2. CJ~.,_~''''" .~-,."........ ) ',\y,,"a;. "".
Electrical Contractor Jf~HoldS ElI!."d. ..t3rc.
Address .2/ 7~ LA/. 2... ~ five .
City E","I el'! e
if
Phone 3'13-72-'17
Supervisor License Number p( 5';z.. (') - 5
Expiration Date
/0/0<'/
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/7 z..-S- Z-
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Signacure of Supervising Electrician
Constr. Contr. Number
Expiration. Date
LJate
3. ftOM:P.t.:ETE$~&.
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A. ~,~':\':'R.~si~~!U!'!t~,~i!igl~10.:,NYI.tf.F:~y~:p~t~~~~~i!,.g.~
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106,00
$ 19.00
Each Manufacl'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. \i\s~~<iW"."'::R. ..~."~~~!iltIDilli'1'i~""\iXfr&16~,<;\:rim6~Wo'i\.r'ii";J;!
~"':~"''':':''::'':"'tJt;~~'':".:t;:!,*~::Q.').q;_'''''''''''2.\'''f-""'",-''[l'~~~~.,~~
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C. ~1"iD:1POr'i(~~~:or:;fe'e(fer~'~!\ty.fJ1P
Installation, Alteration or Relocation
200 Amps or less I $ 50.00 So 0
201 Amps to 400 Amps .-5 ~&2.t\9
401 Amnsf~M'~"""segon laW ''''''IU''- t,1I11Hlll
AI rtO;;r';<::~ 'e<1bvtll..~.':;il")rrt"'''''ll
Ov~(\Q.Ot.A:nips!QflluuO'Vol~.$.e.." 'l[l!p,oyes set tq,rt
'D ~1J~~_"'~- '",,: ~ - >'t:<.:~'<;:<.l;.{ . -.'~"- - ,'lfIo~"1f~~1f.~.";'+~~
. ~_.,,#~~~, ."...'. ,.- " ' .;." ,.."-. .~~~;~~~~~
\ O!llH \:10 - '''P~S () tne
Neoo.M~rf8B"1l!ifuer\sUin ~e ~,~~ telephOne
One ef!li~ihg the center. (Not~.:..,~. ~lgt~i~at\llJn
Each XClo' ',,".1.G" ittOl\w,.1Jiln u,,,,t, ' .
serviP~Jb'rl~~~'::'i~ 1_fl(\n_?:~2-2344)$ 3.00
Q~44b-.-/-::5
own~e ~OSR:J(l.O lwM k,Rt.
Address ---.. 0 150.. 20 E. ~Mh~'ill:ililli\';li(S~~~f~tdr.'\'fiijtiri~a:d}ffi~h'iiiHfjit;tm~,1
+-", 1ib>:;:~'A J";"'''''''I~'"'''''''l~~'''~'f:f1~l~~~'-~'''''''lotOO.'''''''''",,,"';'' '::l;I-."~...".,,.,.-i..~~~;.I.~
City S:?f<t "'6+1 a"U Phone Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50,00
OWNER INSTALLATION ~~~I;:~~i'f~~ANerpffi~@"fj!i'!\lE WORK $ 25.00
:ne in.slallation is being made on property I own whicl\UTHORlfEitYiffflom~'n~rJtIIr IS N~T . $ 45.00
IS not IIltended for sale, lease or renL COM\\1l!liroEI9 &PfISi*lVDlJm!i'fiemFee is $45.00 + Surcharges
Owners Signature:
Inspection Request: 726-3769
ANY 1.!!lF,~OFABO@t~'ti.1i1~;':E\J.ii1Jfai1
. h~~.iZ.~~~:J.:c.;-'~""~+'':'i:Y:~''i:-'1.:,:.~.~if:1];~1~~~:~~~~?~~
s-o
]SO
500
5""8 s<:>
7% Slate Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:YBuilding FormslElectricaJ Permit Application l-03.doc