HomeMy WebLinkAboutPermit Electrical 2003-6-26
submitted has the following
, squire specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . ~~b0i~I)726-3689 I../J
ELECTRICAL PERMIT APPLICATION Zoning L Iljr..
City Job Number ~ Dale r;-l"i!o3 Dete ~/7~/.o1,
. - . -. AIJihonzed Si nature- .
A,
Service Included
$106.00 10 b
3g
1.
LOCATION OF INSTALLATION
V'L.1/1.. LA WN !!.I d t e-
LEGAL DESCRIPTION
/70J2b{ I
AI
0'1/)00
JOB DESCRIPTION
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
tfCJv\,SI.!'
("./1 a...e
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
Each Manufac1' d Home or
Modular Dwelling SelVice or
Feeder
2,
CONTRACTOR INSTALLATION ONL1'
B, , Services or Feeders - Installation, Alterations or Relocation:
,---- -- - - -- ---- -- -
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps 10 1000 Amps
Over 1000 AmpsNolt.'
Reconnecl Only
f~l:i' ;, '. ~r'-j,- "_'~~::-:- ~ - - --- n__
tll, . ..... r0.1:.~ ~~porary Ser\'lcesl!!rr&~eders
"""~i,C', G, i-'iea'O'Tlhe 0 -; ~yetrt:J
':l UA - . enter Th _ r~gon Vt',.,
Iln" H ,'J52.lnstallation, ~lteration,orrReloc.itioit
- J, \'OU n -, vv I U rbrnU h' ~ ~ '" Set for;
C'I' 200 Amps or less 9 OAR 95::> c-
of. linn lh~ - - ~., '111 C"";~r< -..( -... v.
n.. l' - '20n>\mps(to/400 Amps the rUle . $ 69.00
I l.Jeifor" .... ,,.,,to. 'h S I.!
40IL"-mp~,to 600'Ampselephon_' $100.00
r 'r'~,. ' , -: ,>",vn Uti/itv ^, "f' \:i
C?-~er_ 600=~~"s;~r.J~~?;V).\>!l.~eeJr~_abOve,- _ __ _____
D, L Branch Circuits ' ,
___~_...._ __.____._" 'M'~___ ,_____~ ___ ~ _ __..___
New Alteration or Extension Per Panel
One Circuil
Each Addilional Circuit or wilh
I //1/1 7? ~ SelVice or Feeder Permil $ 3,00
'Owne(SName 0-IIT', D/Ctu -
/</7:S ~ , ER:M\Ii:'S~iste~~~ ISeltlEe~~tm\(;I~t i~cIud;d)":E~Ch insl.;(lalin-,~ I:
. ,I ,IG PE I n~R fHiS 'pERMITlS NOl- - -- ---- --- ----
Phone 77ft ~UTHOR'ZED l~r~'!~t{tlGNEO FOR $ 50.00
7VC ^(;> ~MMENCEDs ~~~ net'ghting $ 50.00
OWNER INST ALLA TION -ANY 1 BO DAYr; lieII' nergy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
-- --I
Elec1rical Contractor
Address
City
Phone
SupelVisor License Numbe~ ~
Expiration Dale (J J
Constr. Contr. Number
Expiration Dale
Signature of Supervising Electrician
Address
po;? /J Y
~F-{d
City
The installation is being made on property I own which
is not intended for sale, lease or rent.
~ign~-4 ~)
/~~ '-j-- ~
4,IS'UBTOTALOFABOVE -..
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drivc(T:)/Building Fonns/Electric.a1 Pcnnit Application (..(I3.doc
i
" '"2..
$ 19.00
$50,00
I $ 63.00
$ 75.00
$125,00
$163.00
$375,00
$ 50.00
$ 50.00
___1
$ 43.00
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