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HomeMy WebLinkAboutPermit Electrical 2005-11-4 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number C.O...., ZOO) - C> It( 34 JOB DESCRIPTION 1000 sq, ft, or less A / Z / ~ Each additional 500 sg, ft, or n-d ~ C-'''C<A:- ~ portion thereof, 'iOIJ \U 0(\ la'J'J ,eL\V" ~,,(\ llli\it'i Permits are non-transferable and expire ifworklisl"\', Q{e9 Each\Manufact'd Home oh '"f'.....r::.N\ ......\''1 \ 0\\'1"- ~S""~\'-' not started within 180 days of issuance,'" if'wor~J~ adO? e f'Jri'BgI\'{lDwelling S2.''Ose,or $5000 Suspended ror 180 days. jollO'J'J rU 'cenler, IFeeaeUgh Of>.,P-:10 I s b'i ' ",' _ '..~" , ,..,.. ", " '''I'A\\\\Qa,IIOr:, 0\ -00\ 0 l~f3",,,:'l oj.ln,e .\~,~".. ','-'C' ,to' ,,"~.~,"" ".' 'Je ',~'''.,~""a',,,,,,,, l".oy,' 2 CONTRACTOR INSTALLATION,0NbY-;0 hB.\rl8er,vices or,j;;eeders'1(Installation; Alterations or Relocation:'.~" . ,'! ~ ,.~ ~ .:''';. "~" r: ~~~I "-\I'il !;t.J,[~' 'v,....(tii,Q.')I au...... (~o1:e~ t~:'\e ,~. '.....Xtcat{b~' . .<~ " ;...~"'~ ~ .,.....,~i..>i.y .::t'~'~,":'<:;;. !~,:.~., ,,;:: .,< /l n ,; (\O~<'" I I" renle!. , '''I,t'' ~Ol Electrical Contractor L, re.IU'\' N 5 c..ieG Joe: O,200:Amps or less,) $ 63,00 he v"' "-'2 '2';"" , v-:~ber jor III 'S ~OIC"m"'ps to 400 Amps $ 75,00 0" '" Ie' I " P-,cx 11/3 cen 401 Amps to 600 Amps $125,00 601 Amps to 1000 Amps $163,00 Phone f''15 - '/'1 d,d, Over 1000 AmpsNolts $375,00 Reconnect Only $ 50,00 New Alteration or Extension Per Panel One Circuit $ 43,00 Each Additional Circuit or with ... , Service or Feeder Permit $ -,.00 ~ , , "',' " ":"L\'C:''N~?''''"''~, .. , ," , E. I l\jiscellaneous (Se,Qjf,elf""<1fr~H!lI'lu<Ml)'-Each Installation' Q1\C\:,', ' "S\'\i'.\..t"r.1'<,\r\\. t.?~\"Ii \':>'\'lU..,..",. '. <.. " l/l:, 3 ~~\'\\~~\L\\V~t.? "Ii\,\\S 6Q~c:n rQ? $ 50,00 1\\.\1~\1t@b~tif!l;i'.'OI\~ $ 50,00 Ccl\\\,I.>tt~If~~\(l)!i\lial $ 25,00 1\~i/n1tWIlrl~gy/COmmerc1al $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges : . .., I. LOCATioN OF INSTALlATION' , -', .' .~, ..,.,'.". '. '"" . -Z~ b 7VH-- P L LEGAL DESCRIPTION 170z.. 35"'i2 "Or '2-0 Address po City Ut"~ ud / Supervisor License Number ;) 9 7 t/ - S Expiration Date It')- &1- a,7 Constr. Contr, Number IS: c; S. ~ ? Expiration Date lJ-IS-of? Signature of Supervising Electrician fl1g-~A!~- Owners Name J4fld1U;,( I~AJI ~ 7YfG<. I'L Phone 7V7 - Address 2-J6 Sj::::>I:~ City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 ajJp'UYtll~-~ L'j)/2.... 1.11-05 ~ 0-> -JI"". I , d SiF~~tLP~~ '.(F<:::!::~~~:;i:'::;'~;~;?;\=';2;~t~~~~~(~: "_;'_"~~'-""..:JJi'''I- ~ 'Ill!>:>' :~'iiI~):Jt::~~f,;.22;:.._ ~YI ~~ Zoninr' Dale /I - L(-6)' 3. (COMPLEl1i FE'E SCHEVC1LE BEi6'~v:rtr:Yi'~';';\\~~'?):!i~i . ':. .' ",_ ':"" _, ,''1 '.''-',: . _.. < ",..";,..,, . ~., ".'. i. ..~ .:..::,,'::..,~ ":!'f>""'~,.>:~':i}:~:;;~,,~:,,;,,::,;,;,>"i~: . _. :..' ' , _' . _' ...;,.. ,;"f,'I-i~'''7\,~;:-.'1 ",' -.r,. "~~;""'"~ ~"'~:':~ ".':-',,_~., ~;"~,;.......,, ~'):";~;r, A. ~i ~e\~; ~esidential,~_ S.ingl~j?t~Julti~.Fa-mi~tper .~)":.el"ing'uni(.:7~~ ....,'. ,...~..,'" "_'.. ..,J.. "_' .... ",-n_'''_'' ~~".~. -,~,,'~ "..,0............_._,,_'_. ~".", .... .l- ,.,,,""'_~.. Service Included $106,00 $ 19,00 c. t~if;,r~~ri'r~?r.'~.~J~?~~71i:-~l~#~B:!E~:~~~,~~~i~~~;~~~lf.~f Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps $ 50,00 $ 69,00 $100,00 O~er 600,~mpsor1000 Vol!s-,ee:'B'''abo~:, . " ,. _ ,. D. -::. .~'f:~ ~:~~": ~}~~.u ~~~.~:~~j.tf:S~!:~~.~L~~J~:~:~~~flfZib~~jl;;~t1~~~7~~~~~ Lf3 " ',' ,: ','t. ';. (, -:'::~~">'" :.1<' , , 4.: SUBTOTAL OF ABOVE';" ',' ",.J.." ' "':" .. ~':.:"" '';.' ". >,' 'If, JZ'Z. l{&O $3 8'Z 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/BuiJding FonnslElectJical Pennit Application J.OJ.doc