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HomeMy WebLinkAboutPermit Electrical 2005-12-15 '--i-../7 kLl:. '--- :~:~f1.~!tr~]~ ..~...'.... '~~"~l' 't1'\ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)2~~~<ill" :;:;,'r; ". ,- - -i,;' I-v J ELECTRI~:IT APPLICATION , ate L "I,.r~ "<J City Job Numb ~- 0 I Lf ls 7 .' Date I ~ls"{n~'&:;. I. i;L'OeA:T "ONOFtiNSiALi3AtidN,;'<".,;'f;'j 3. ~'COMP'iEiEFEE:SCHEjjCJr;E!iiEtOW."~,$, /wltp "-~;'O"~"""'-"'- ~ _...fu >'"' ,.=_.,,~_.~-~ .., ....--...- 'h",u-,I"".,~' 11 L()EGA~L D:3ES4CRIJ,.PTI)ON. ~I Y A. re'N~~i.ir;r~~;!i~"Jt~'i'fiiIF,iriiilY$~~'1iiriEn~? . ~~~~"-':~~~"1:ll1'; r.J~"k"""-- rF"....-....,.'yj Service Im:iJefe'iiIllT10N: Oregon law requires you to ,,,/ UV JOB DESCRIPTION 1000 sq. ft~l6'J1~srule~ adopted by tit Oregc$I06tOOY I{ M. e-' -:-2./7 Each addilfb'ri~f:506'rlft',rdrr. Tlluse rUles are set fortn qS 07> ~ V c.-- portion tirer~lfrK 952-001-001 0 th~h OAR$li9:00:J1- . 0090, You may obtain caples 01 tne rules by Each Manufact'd Home or (N ~u..!, '>J ,,><, ,,,,mter. ate: the telephone Modular DweUmg ServIce or , , Feeder r'UH'U~1 IUI 'He Oregon Utliltv l\!gt$~Q:o.Q,n , Genter is 1-800:332:2:)14)" B. ffJs~~1~:Js;:~i~':~F~~r1~~i'nsi~W~1Y~n~;;\W#iiii>~s .6~'~'1iJo~'D'tr&8~: ~::'.I ~ ,;.....;... .:_i:'<....~-Y'_~.,~,,~___""-___-....,(.~...-.....:....t,......::- .~,'~,.~'tl.,..'-""I--.. .,. ;1- "'''''P!,' '';,c:Glmv;O' TI iRING' FIEP;l"';O""cc'G'ON' "t.,. ,', ,-", ,\ ;" ;"i...:~.,'t,}:" .'"v~. f' :..1'~.~., r.' ~ .L'.cJ'~'~'~ :d, 1 ~~'C ~-:~~ ~l;."""~I+."')."~ "",1, t1.4:fu~1"~.,~...~. \""".-~~' ".t~ ..-~.,c'"#:'-'..r\.....~\.J."'~"....' ;/_ ..,...4.... .,-.;:~~{:.,..! ,_ ,j, ,_ ,-'_' H.... .__,..~1'.. _,...."t,4J . .",'>.t., ~.... ,.-,.... ,'\,..,10', 4,<<.......!~ _ ...,.le;:.. .... ~,' ,...~. Permits are non-transferable and expire if work is ,;. not started within 180 days of issuance or if work is ' Suspended for 180 days. f~c@fRAcrORillVsTAi;fiA?floN!ONL. 'y;'1 2. 1\.~'. ."w,...- "....~.,;. ....";-:,,--.....',.,~,~,,_.~. J'__' 'f,"'::-x.~.,.~ ...,J Electrical Contractor ~ rCL 6/ teAV'I 1_ r:-"\c. 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 AmpsIVolts Reconnect Only $ 63.00 $ 75,00 $125,00 $163.00 $375.00 $ 50.00 Address Y-I (0 5 'S~r"- s+- City ~U1Y\.R. Phone '5).. 0 - (P<l@~ Supervisor License Number 52 '8'5" 5 Expiration Date to - I- CJ 7- c. f.,:i:~mp~~~ry~"$~ft~~,~.~!:~F~~a~.fst'~'~ '.:f<~,,/ ~ ~'I~'::~~\:~~'" ;" " " i ~,"':f,'" ~,. .;' --". Expiration Date I~D(lIr "')-/;' 0 (p Installation, AJleration or Relocation 200 Amps or less $ 50,00 201 Ammrrt~mps $ 69.00 401 Amfl1\'S6Il~rffi1rr SHALL E)CDIR~ IF.-me<W0plC D,Oi~:;~.-jfI~*~~~~Jf~A~~~..i~i:~,,:,i;~ New AJt~Jll'lio1M ~~.rM'9Q. Panel Constr, Contr, Number Signature of Supervising Electrician w~, 'Ii J~ , Owners NameOoJ') Q P ) ArIUJ Address ~\35 ~\-o..f' h C~CrQ / Phone554 J17(P7 - G<dJo'^-L-- q, y;:) u OWNER INSTALLATION . , One Circuit Each Additional Circuit or with- Service or Feeder Permit $ 43.00 . $ 3.00 E. ~Mi~tJffai1~6a~\'(~{J6ice;fu':d'~~: fiBi 'li~~lad~d )~;E'i~h~iii~t~ll~ ti~I'l~;l .'~. ...\..i_.....-.. '....'...v..v,V""._~.~,.,___.;-,c"........_~" .. "..., ......,. ..^..... "Fj The installation is being made on property I own which is not intended for sale. lease or rent Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50,00 $ 50.00 $ 25.00 $ 45,00 Inspection Request: 726-3769 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~,"""'-"-~." A.,~,;~_,,,,,.,,,,~,;,",,.,,,,,,,,;,,,,,-,,,,",,., ',";;. "'-'1~() I ....., 4.'SUHTOTA:l:lOF:ABOVE~V1,W,,*,$7,;," ' ' C) '-' . ~~,~_~~~:::t~~~:.,. '71., ~ ,,~{.~,,-~.,5i.,.~ ,..:a.;t.~ ""1,c~, ,~'.. , ' 14/,0, t;1t) . L9 ~~~5.17 7% State Surcharge 10% Administrative Fee Owners Signature: TOTAL Shared Drive(T:)IBuilding Ponns/Electrical Pennit Application I-OJ.doc