HomeMy WebLinkAboutPermit Electrical 2003-5-13
CITY OF S()NGFIELD, OREGON ",,,0.,,..
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 .<F'~:~~'lf:f6~~689 I".A
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ELECTRICAL PERMIT APPLICATION -I, J. Zoning ;"'l~- 0 ~
City Job Number (OM 7.nc."\ _ <::>0 Y-f, Date "ji/ Y_d_'5:~"tc . ~
I. LOCATION OF INSTALLATION 3. COMPLETE'FElistif1f5'f/LE BELOW
b T>"-( 'JA CO cf Cd
LEGAL DESCRIPTION
17023'11/
07.300
A. New Rcsidential- Single or Multi-Family per dwelling unit.
Service Included
JOB DESCRIPTION
1000 sq, ft, or less
Each additional 500 sq, ft. or
portion thereof
Each Manufact'd Home or
. Modular Dwelling Service or
Feeder
Tt:WI P
i?8ve1L
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 18.0 days.
2.
CONTRACTOR INSTALLATION ONLY!
B. Services or Feeders - Installation, Alterations or Relocation:
Over 600 Amps or 1000 Volts see "B" above.
D. ~Bra~-~h-Cjr~'uit;. --- --"- ..- - ---- ...
\0'
New Alteration or, I?,xt{,;~ion'fer Panel
u\\C"- - \)\W~
One Cirq;,i!1 ~eo.: ,eQ,O\\ ~ \o{l.\'I
EachfAlliaitinnaR:ircuit<o\,,'a,lth\Q'\ .
-"IV'!) ",,,--v' ""V' r;.,.(,.,'J $
----..... O~'.\:;ervice\or'I'Cedel,rPermit, 9.. S "''' 3.00
Owners Name .J.:)t::7'f(lfr:> .(Hr..v(<A~\~ ~60'9'--<",OS'" ",Ut'" ~\}\e
~~es"",~,'II' 'O\}Q,\' '~\\'Ie -\\0- - --" ..--. ~
Address "'67'1 r T{..-.~--sJv- ;:1. ,.\ ~~ ^t.e\\l\\Us"l'lla'i\~ou~,(S~h;is.o/R~dler~l1ot included) -Each Installation
_ - ,0" Q,\.I)'-' "'(\CO'lL \\'Ie'V" '~\ea>' .. - - --- - - -- .
C P Cf) . :i.\~\Ce: S'l.'Cl 0'0\'3'\ \,,\e'. ~O\~
:> I Phone ~O ~ f>,~ <:\ ~wj1p ~'i;irrigatio'b\\\\\'l ~c.A")- $ 50,00
\\\ ~~". ,<01) "Sign7&tline-;t9(\ghting/2: $ 50,00
Q'-'''v . '\II' €,V' 0"'''''
OWNER INST ALLA nON r'i}\\\\\'tJ, l.:mi;a,o'En'er~lResidential $ 25.00
V :oe,' leI Iv
The installation is bei~g made on property [ own which \\I)~ Cinfited Energy/Commercial $ 45,00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surchargcs
Electrical Contractor
200 Amps or less
20 I Amps to 400 Amps
. 40 I Amps ~o Amps
~OIA ~1.,9'iJOAmps
e~' ~ti~&,psNolts
\.. ~~~ &.~liUi'JY
~~~ ",'x" ~\(\\)~- - - - . - - --.
,~1\1.."~~' :J~ SJ:\\)~~ ~~\"TemporarY_S~vic_es or ~eeders _.
.t\\U,: "<~~ :t~\) \)~ '\ ~.
J J r- ....'(.\;\~"'~\ ,,"'5~ '?~~'iS Installation, Alteration or Relocation I
o - ~\) ~~'i;..\; \)~ 200 Amps or less
(,'is ~\ \~ 201 Amps to 400 Amps
~ ' 40 I Amps to 600 Amps
Address
City
Phone
Supervisor License Number
Expiration Date
Constr. COlltr. Number
Expiration 'Date
Signature of Supervising Electrician
City
4. . SUBTOTAL OF ABOVE
o
7% State Surcharge
10% Administrative Fee
Inspection Reqnest: 726-3769
TOTAL
Shared Drive(T:)/Building Fonns/Elcclrical Permit Application 1-03.doc
$106.00
$ 19.00
$50.00
,
$ 63.00
$ 75.00
$125.00
$163.00
$375,00
$ 50,00 .
$ 50.00
$ 69.00
$100.00
5-0
$ 43.00
50
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SOD
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