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HomeMy WebLinkAboutPermit Electrical 2006-4-12 Date ZON U'I2- INITIALS ~ ~ DATE I-l- IJ _.-0'" SOURCErJ0-'9~~ 4 -Iz-~ Gao<o '# 225 FIFTH STREET. SPRtNGFtELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRffAL PERMIT APPLICATION CityJobNu~m2.(1)5 - ()115F1 t-."t:r>'"^"~>: Jf"1:~".}rlf,,'~~.q':~~'.:...~ " \;<,,':v';~r:'i~;;';;;-;-_,,;.r~,,''''-f*;<i;_>;~1\N 1. .' LOCATIONOEJNSTALEATIONii"r'7}!;:iiii 3. \ ,,,,,,,., '''''li~.",,,,,",,,,t,<),~,,,,,,,;),,.,,,,,..,,,.,,.:!",.~,.u;,,~~,,",,,). (( 3R' l J1l i'l f\ 17 ~r\ ~ '~\)...L... LEGAL DESCRIPTION \'103 ~ 2- \ (90 btsQ 200 Amps or less $ 50.00 201 Amps to 400 Amps $ 69.00 . 401 Amps to 600 Amps $100.00 N 01 I ele~,~,~~ ~~~.?~~2g2';;'.?c~~'~';.~~~'~~~~:'.:'i>""")i" .~~,,,,,,-~~ Signature 0 f Supervising Electrician T H I SD,., ';'~B~a rich;€ir,;':ijiis{-tlI"1i\1ai,ft1;tH8JN~gJ,B~~,;f$: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 tkU %IQA'h ~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is . Suspended for 180 days. 1.~'1;-:5.'f.:;Y+!-~'''Fi~~'V-<}",,'<;>'''''';;;:?::'-';-J:::'~<<'47'..J;f;,t\t;t,'~:';'t;';t:;2n~f;'/c;-::p''I$_;r\j:;1;~ i;CONTRACTOR:JNSTALliATIONONLYf 2. ?-'i-',ii:I:~1;:.0.~:;:~t:~_::':;,4~/,;-!l:-j):1i[!J:;;i.",,"2;J.~;QdiJ';,!;..~';Z;tn'i.:_~-:i;~,.,;;x'&~ Electrical Contractor (!. .pe.R-IlAL<; E/e~c.. 1/93 Phone $7.5- yyltJI:, Address P. D, l3 0)( City (2/ZestJe) I Expiration Date. 2. 970- s /0 ~GJ/"- 0 /' /.5 9537 ,/-/5 -Og' Supervisor License Number Constr. Contr. Number Expiration Date The installation is being made on properly I own which is not intended for sale, lease or rent. Owners Signature: InspectionRequest: 726-3769 f',",-~~\ ;,;~""t~"i-;', :;->-%~~:_mxr""'~7""'~):o.~V\'F"~'+\'V~!";;;:''!'f>''''7'{,...,u::,?-~,~''f~/';~~<!I'.;.'''<>t>'7'' :~:COMPLETEFEESCHEDULEBELOW*\ii!iif.j;.,,,;,;,, .. '.. t;i~"J;:'.~;::J}.i'i'?t,:;",,~:t;-'~~\:.L.0';""'~'~~'~'illt.+J..ul>;;~::":':~"'-.\.S.u..).,,'S~'g_ii.f'!;c.r;'~\~rEtli:J..._; "3;:AJ;',~r;K;~'i>f!{/~.'~'f!:;.'0(?,Wf!$!Fp.;-:r.tll,<,&-.p,~!f;t'?:iT;~~g;'t;:;''F1:q,).~;.\'.f7;;;\c"tiP ,.",~::;!t.. A. f3N c".; ,Residential,*$ingl,c~or.)VI itlti:Fam il)<per~:(hvelling,~ni . ~~\_r:;,,,'...~"-,,,!~;;'~'i:;'~iX,';I.~~.\<i~~A)'...>'C;,.:t~~,;\~-L';';';l,;c,.:;:'l}i.;(,,~\\~~~~"" Seryice Inc\ude~ o,,,,,on law requireS you to 106osq)Lol:\e~slopted by the Oregon Utl~~~lW6.00 Each additional'500,sq. ftr6r3e rU.es '" '" ~'" , p6rt;onvih~;:';~(OO-1 ~001 0 through OAR 952.0rs\9.00 In U/"\tl ;:J..Jt:- . ' oy _, ~" \1_ ' "",' " .,ht~in copies at tne rult~,:) Eac!i,Manufact.d Home or . the telephone M d 1.. = "II' -,s..~,. ("tote. o !lar''''.Y>'e mg: erYIce or .. N tificatic$'50 00 Fee~~mber for IheOregon. Utll~tv 4~'. . ~,,,_,,.,._.r~,,,!,,,,,,,'s,,t_aQn .;l::J?'6"".".).,,~_.........,..-_.- """'~"-";' i' :_'C" "',:), ,_,>~.,~,':;~~\.;"r'!2'~..;t'-_j-,.f~~~~".<::r.,L\:"''f.}?''f'-~:'~''~' "~;:-.'i"'\:l: ~""f..;~..h' ,~'v<'.;;..<''t')''\"V''?0: 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 ~t::':~:::~"?g3~)F~';"';1'u;;J4'1;??t?'\ 4. fi,SUBTOTALOFiABOVE &A!il~'t~hi(;z~%:~:10;d~~i:i~~';(~2,t' 8% State Surcharge 10% Administrative Fee .......,.. 61) ...."...h~ ","'>''''' ::JJ:i/p . .3 .(PO '{,56 53. i;() TOTAL Shared I?rive(T:)JBuilding Forms/Electrical Permit Application l-06.doc