HomeMy WebLinkAboutPermit Electrical 2007-1-2
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I; _1\''\__ .' __._-,,~J: INITIALS _ [\J TV\
! -~_-- .",! DSOAUTRECE~ '~~~I ~~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ~ ....,. ~ ~. \ .._ '~
~~~o~~~C:=~~L~g:g~'Z- Dale 'I/~~OO-' .
1. l LOCATIONOFINSTALIATION: I 3. I COMPLETEFEESCHEDULEBEWW ~
1<6:24 ~ulM;dd Avp ~\c;l!dcl Ole '77<f7 7
LEGAL DESCRIPT)QNU \",/70 J Z~z.f A. I New Residential- Single or Multi-Family per dwelling unit. -'
~1Af'l-..c W oX OO~ Service Included .
JOBIDESCRIPTION: f) IQOO sq. ft. or less $106.00
fe ^~"'~ q (lIp( fI-;Se.~)C ~d Each additiona!' 500 sq. ft. or
41r.vi ),,, ~ l..) :-11.., ...... ., portion thereof $ 19.00
Permits are Don-transferable and expire if work is Each Manufact'd Home or
not started witbin 180 days of issuaDce or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder
Owners Name -::J;.t '0-... LJ",.N"'P_ ~
Address t <t d. Y~l '" ~~ d:j" A",,,,_ - E. t,:Miscellaneous (Service/feeder not included) -Each Installation I
Cily '1..,,0_; (Je 101 Phone 7i./t./ - '? .;z~llmp or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited EnergyfResidential $ 25.00
The installation is being made on property I own which Limited EnergyfCommercia' $ 45.00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is 545.00 + Surcharges
/oAaturL (~'" ~- _ 4.1 ~1~t:~:h~:~OVE I t-.s~'VJ
~ 10% Administrative Fee C?--
5% Technology Fee
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2. r CONTRACTORINWALIATlONONLY I
Electrical Contractor
Address
/
City Phone /
~upervisor License Number ~~
Expiration Date W)
Constr. Contr, Number
q
,
Expiration Date
Signature of Supervising Electrician
Inspection Request: 726-3769
$50.00
B. r~ervicesQrFeeders - Installation, Alterations or Relocation:
2bo~p'sjJ}'lb~sv '- ~J';11 C. . " ~~....'V.//~ Y~~J63~OO , J
1-"0'" rlll"'c '>d0nrRd by tile U,f;;VIl lItll'llI
201 \l\mps to'400 ~mps , $?5.00
N'4Oiil/f"t;fs?/ii6'o'W'nfpIhose fU,,,,,:' ~:""'_:~I~~:clb
in I"'IA,R 952-001-001 0 througl, un' ,,,,,,<!-UU I
O~~A~3~t~,IgSO()t'l'Bfn copie::;::;~ :bc .'J.b6~.gq
OR~Q\ll~nttob:g'lr~ser;y~t (Note: tt;;:, :;:,:::;;::-.$$' ~510~0'000
econnec n y. '1' :.. .... .
numbef 10rlhe Oregon Ullliy "v"".;allon
C FT' ,"{''''''~s''{w."li:l:mP.:'F"1(P;:?::l441'
. w~DJ~J..LT.E!!~L t:alers~
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
ov~rQdJ~ps or 1000 Volts see "B" above.
D. L:Bi'\lilch'Cif~tsSHAll EXPI8EJ.E..II:lLWOal<'
AIJT4npl7cn IIf.Jnctl J' ,.(" ""'.-~' -
New Alteration.or Extension Per:Panel M I TIS NOT
oh/.'<WJiiNCED OR IS ABANnmlm Ft1?'OO
Eal:hJJ\dditional\Circuit'oru-with
S~~e ~rvFe~er'p~rir:il1 u S" 3.00
TOTAL
Shared Drive(T;)/Building FonnslElectrical Permit Applicalion 8-06.doc