HomeMy WebLinkAboutPermit Electrical 2007-12-4
~-;;'''crl~Y 0iSPRINGFU;,LD, ORE6~N,' -
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225 FlITH STREET. SPRINGFIELD. OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRlCALfERMIT APPLICATION
ptyJobNumber Gorn?{)O(? ' ()/lILf5
I. 'LOCATIONOFINSTALlATION:
xY<; S- 6'(;;'.jf, '-~?
LEGAL DESCRIPTION:
If: (J J-, ()L-j 1/ Il L.j(J):J-<)
JOB DESCRIPTION:
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P~rmits are non-transferable and expire if work is
not started'witbitt-Hlll- j,:;: :' :..___", or if work is-
Suspended for 180 days.
CONTRACTORINS1'ALIATIONONLY
2. _....__.
Electrical Contractor :i!r>se ('i1 ~J2.A'f",b>ot.
Address <k,/.pS W II-nr ~1r'
City~
Phone .h.JJ.p-61l>>
Supervisor License Number
5'1'-13 )
q /30/2-008
Expiration Date
Constr, Contr, Number 7I":.- 2S;f./
(>'11 b-g
Sign71lJrvising Electri' _,_
~,
Owners Name ~_;. ~
Address !( k< <: ,5/',vh 5'/
Ci~j ~ Phone 72-b -- f-t;83
OWNER INSTALLATION
Expiration Date
The installation is' being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspectioo Request: 726-3769
";,-..
c.G
INITIALS N fV"
DATE I d - I 0 - 0-(
SOURCE 'NV0 ""i'O....
ZON
Date /;) In 2//6'7
3. COMPLEl'E FEE SCHEDULE BELOW
A. . New Residential-Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 "I. ft, or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$117.00
$21.00
$55,00
B. :. Services or Fee(Iers ...."lnsblllation, Alterations or Relocation:
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
c. : Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B"-above.
D. Branch Circnits
"",;," .
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
!
'7v
$ 70.00
$ 83,00
$138.00
$]80.00
$413,00
$ 55.00
$ 55,00
$ 76.00
$11 0.00
$ 48,00
$ 4,00
E. Misc~II~,n,eo,!s (SerY.'",,/feeqer not, incIudeq) -Each Installation
Pump or irrigation $ 55.00
Sign/Outline Lighting $ 55.00
Limited Energy/Residential $ 28,00
Limited Energy/Commercial $ 50.00
Mini,mum EI~trlc Permit Inspeetion Fee is 550.00 + Surcharges
4. , SlJ.t>Jv.lALOFABOvE
8% State Surcharge
10% Administrative fee
5% Technology Fee
TOTAL
:J'0/
,
Shared Drive(T:)IBuilding FormslElectrical Permit Application 7..Q7.doc
ZON
INITIALS
DATE
SOURCE
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726~3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CO/lll2.0b '" - DI'-iY'S
1~ i'i~'?fL~fj~!~ldf~?i~~~j~
LEG/&gz:..Orq( ( 0 l{ 000
Installation, Alteration or Relocation
200 Amps or less $ 50.00
N,- - 201 Amps to 400 Amps $ 69,00
T. u liCE' 401 Amps to 600 Amps $100.00
HIS .
Pf.qp",1T Over 600 Amps or 1000 Volts see "B" above,
AUTHORl2 SUA~1i' '<-'~'''''''~'i!!lml'.~I1!J'~' ,"",'1Ili!lll~IiI"m::~,"""~~~~"' "" '.
COM ED U.;,ma: ~ '" rCUI!'ii~-9l',,, .;'~5':'lc\;~jl~-",e;( ~,,,,<..: ,",!ii^lijWk'z?~~~"'j .J,.::i~,;L,,~~"'"~
ME IvD '1f:"'~" '.....",.. -""""... '''''''''~_~C''
ANy 18 NCED OR I J'1it8'})~Ii&WrJi'tr(per Panel )t6
o DAY PERin'" Bl1IitQqillMr- IT IS NOr 5-43:00
v"'ich Addi'rlbYmfrpO/f. or With ,..-, ~,f
Service or Feeder Permit '\ $/J.OO
JOB DESCRIPTION:
AJ.[ ~ <:.', vc.....:-tr L St-\. '(("
Permits are non.transferable aDd e pire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. [~II!iiS!tit~~1IflJlI'1l1]
Electrical Contractor
Address
City
Phone
~"'/
il
O\J/
!
Supervisor License Number
Expiration Date
'Constr. Contr, Number
Expiration Date
Signature of Supervising Electrician
Owners Name Eric.. FetrY'"
Address '385 C;CVTH St,rH sr
City 5f,i(J:,tlield.,O,ephone 72t:- ..'('-/'33
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
Date 11- Olc- 07
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,,'" -.'" .,,~C',,"'._ '"",''' ,,", """"'~,~,~-,,,,'~.'_.'''''o,,: ,,"'":"". +';:;";Y-;i!~'3i!ii'}'~'''''"-''''' ..,.....'....""".' ,. ,~c>,_,.",", '" 1 ,'"
A. ~Ne"mesiileJitia1;'&Siif e~oi',J\tiilI',,"H!riiIT.r'lIwelliiC'unit2 <1
!t":i::il;'liol,;",,,.,-,~~..,,,.,,~~:t;Jt;1~~:ii,,..,;,,..,,~.;,,.,~,,J""'-".",...."''''U.~'it!',;t.1"''''..r.;'-~,p.'.~~'i;j.liif''' ' ..,
Service Included
1000 sq, ft, or less
'Il . E6ch additional 500 sq. ft, or
rl7VL"jortion thereof
$ 106,00
$ 19,00
Each Manufact'd Home or
IMod,ular Dwelling Service or
( Fe'eder tln"l
,I' .' '!!;t, ~ . IV: fl.._
. "r~"il~'~"'''''R.~"",~",;''",1!rg,\j!'i~...iiii\,'7"'''~'~'''~:'''It'1'1"'i:lt'l'!~"'~"~"~"'I"ti"~ti'" ~{!!l!"""B"'''"''I~''i'''t'''"''"~'''''' I,' ,
' .".. C<1S;'ur,"l&l]Je e 'S" II a '!MI" '''~,... ons',or..' e oealOD" ,~
In '/1 -',\. ;"'",'},k;E1>~,l,,,_,- . .. ~li" " '"'''''' ,~~H~"" .J'(~"""",~,\:jt~"'",~~-,"",,,m'W""r ::
"rgJ~rTt ' ' " .",' '. ,"""'~.. '~,... ,,~'.., ,,',' ....
0090 1 52,on -, er, II) e Or S You t 70 0
cqlpltOtffi.fWlf 6r~~0 tl) oSe rUle egon u? 0 $.k3':OO ,7
nlJrn~'2iJlt~B'tt84Ilf1il;.~8'?lJgl) o~~e sel,;ltY$ 75.00
~6fClrrft~~?8f(;t)O(N8~:es Of the 952'n(/;~$I25,OO
laFl)ttQplio!fffiJOJ.1..i9P.{he tele/)~lJles bV $163,00
Over 1000 A~_lty NotifidlOf/e $375.00
Reconnect Only 2:344). ql/oll $ 50,00
$50.00
1-lrr~mm"'-~~s~t".,~~=,,,,~,---,-;;,,;w,iW!!l-' "'~.. ~~~'''''''-~. .."'-"'.i!!',t!r,7.,;......--.,..,..~""'_....-'
C ~t::":;",;'"'~,,"""i;:-,if-l!;', --.""",,-,C;,i>:f,'t~,\ta:,-"'-rAb'~~' ~ '~. .";"_" - !i4'1,J":;;'.,w" . ~';!0.' ~'\l01',l~...L""!_'"': '"
. -liJ-;e:. ra.i." :en!lces;\O:l'k:necuers=,",-i;1"'" n" ""',,c.,~}.,,!.I, '--~'ffi.'""'lI''' '_"
"JJlPe""''''j,~"-,,~,-,,,.,-;;',.,E'!ilio;:;>,~~'''~k'8i!}'"'''''''' """"j~,~.'ikiif,l:!';2!"1li@FjffiEl',,;~g
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E. ~)Nif~'~iii'ft~~t1~f~~~~i~llufdV~'t>ijf~froo1d~~~ln~lli~trllitwt]~
r::~""-""''''''''#'''-\--';'''';ili:t~~~~mt~~~.l!t'''',.''''j',"O;:';;'''/i';.t;:';';'-s.-;l!C,..i"~~
Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50,00
Limited Energy/Residential $ 25,00
Limited Energy/Commercial $ 45,00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
~,' ;",,":P";~t\;'''V;''~'\-';!?'''','_:.4'''.';!),'i'W..~~t.~~i,L'~;!!!l,',.;>li>,,-".",",Xil.-:.',~"',:'%IJ,'~.;i.'\'f'"iif,--,j 9
4. '~~f~112~~1lL~~~~~I'i~~~[~i~:tlil~~ 0
8% State Surcharge 720
10% Administrative Fee "
5% Technology Fee If jD
TOTAL 110 ~
Shared Drive(T:)lBuilding Forms/Electrical Permit Application 8-06,doc