HomeMy WebLinkAboutPermit Electrical 2006-4-12
Date
ZON U'I2-
INITIALS ~ ~
DATE I-l- IJ _.-0'"
SOURCErJ0-'9~~
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225 FIFTH STREET. SPRtNGFtELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRffAL PERMIT APPLICATION
CityJobNu~m2.(1)5 - ()115F1
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1. .' LOCATIONOEJNSTALEATIONii"r'7}!;:iiii 3.
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LEGAL DESCRIPTION
\'103 ~ 2- \ (90 btsQ
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
. 401 Amps to 600 Amps $100.00
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Signature 0 f Supervising Electrician T H I SD,., ';'~B~a rich;€ir,;':ijiis{-tlI"1i\1ai,ft1;tH8JN~gJ,B~~,;f$:AiiJ:.;~,~i,~.;i;;:,';i;'&';;f~~;;1~
r EMWH.l~u:a.Li.;t;.,~:t5;!_dIA1.,:0__~J5<~"",B;,od.ti.~~~\:;,r"",o:;4.~.;;l",.,_.iZ"'~~-~J. - --~
(Jo'. n "'~. ,,,,.,.ro T' "~ or.RMp'T 1<: MOT
'-IrL ~~A- ~~~~~~:[:~~:~'~SABEA~DO'NEDeF6R\iet { $43.00 4-.'3
(k ANY 1~'l.ch:;AdditiMirI)Oircuit or with
L _ ~ L. ~\- A Service or Feeder Permit $ 3.00
OwnersNam'~ '" D Y'-
Address \~<;<' (I I {)n() _ (i !JyJ:. ~J~~iJEf::~;~~1~~?;~lf:!~rF~~'[~ft1~J';~~~~1
Ci~~ ~ ~~hon~~ 6\lf-CoCt
OWNER INSTALLATION
JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is .
Suspended for 180 days.
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i;CONTRACTOR:JNSTALliATIONONLYf
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Electrical Contractor
(!. .pe.R-IlAL<; E/e~c..
1/93
Phone $7.5- yyltJI:,
Address P. D, l3 0)(
City (2/ZestJe) I
Expiration Date.
2. 970- s
/0 ~GJ/"- 0 /'
/.5 9537
,/-/5 -Og'
Supervisor License Number
Constr. Contr. Number
Expiration Date
The installation is being made on properly I own which
is not intended for sale, lease or rent.
Owners Signature:
InspectionRequest: 726-3769
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:~:COMPLETEFEESCHEDULEBELOW*\ii!iif.j;.,,,;,;,, .. '..
t;i~"J;:'.~;::J}.i'i'?t,:;",,~:t;-'~~\:.L.0';""'~'~~'~'illt.+J..ul>;;~::":':~"'-.\.S.u..).,,'S~'g_ii.f'!;c.r;'~\~rEtli:J..._;
"3;:AJ;',~r;K;~'i>f!{/~.'~'f!:;.'0(?,Wf!$!Fp.;-:r.tll,<,&-.p,~!f;t'?:iT;~~g;'t;:;''F1:q,).~;.\'.f7;;;\c"tiP ,.",~::;!t..
A. f3N c".; ,Residential,*$ingl,c~or.)VI itlti:Fam il)<per~:(hvelling,~ni .
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Seryice Inc\ude~ o,,,,,on law requireS you to
106osq)Lol:\e~slopted by the Oregon Utl~~~lW6.00
Each additional'500,sq. ftr6r3e rU.es '" '" ~'" ,
p6rt;onvih~;:';~(OO-1 ~001 0 through OAR 952.0rs\9.00
In U/"\tl ;:J..Jt:- . ' oy
_, ~" \1_ ' "",' " .,ht~in copies at tne rult~,:)
Eac!i,Manufact.d Home or . the telephone
M d 1.. = "II' -,s..~,. ("tote.
o !lar''''.Y>'e mg: erYIce or .. N tificatic$'50 00
Fee~~mber for IheOregon. Utll~tv 4~'. .
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B. i;~Ser:vices or,F eede'ts'ld.Ilrst:al~a tion~Alterati.onf6r",R.elridl ti6n::~:~d
!i;.>:E~;..t,;.j:t:~;~'_0,:;s..~f,;;..ir:J:.e~'1~,~--"'1~v.::~:;,.'t&.l:;;Aa~\J,?:::'it\,;"-~'J;bik~~J:,.::.j,1:i!1.;',t,):JJ-
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNollS
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.
Installation, Alteration or Relocation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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4. fi,SUBTOTALOFiABOVE
&A!il~'t~hi(;z~%:~:10;d~~i:i~~';(~2,t'
8% State Surcharge
10% Administrative Fee
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TOTAL
Shared I?rive(T:)JBuilding Forms/Electrical Permit Application l-06.doc