HomeMy WebLinkAboutPermit Electrical 2004-9-20
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225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54I~6-3689~( "0- "',,~ . .
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ELECTRICAJ<PERMIT APPLICAT!9N . v~ ~",""''l''~'~
City Job Number ~d.t5DLj _ 0 117'iJate q I b{) I () ~ 0",'''0- 1> 0'~""''''V6
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LEGAL DESCRIPTION A. t'lN,e",;'R~sidentiat{S.iiigI~i9t,:~14IfH:a' . V<"P.'~CIY!' li~g'iiI~),~l."'l
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I "1 0 ~ d S :L l Q &, '7 6l) Service Included
JOB DESCRIPTION;'
IO~Q.sa....fLorJe~s $1
E flnda\li!'1M50'O'~q~Wb~qW reqUIres you to
R~I~\l.l'thWJbf adopled by the Oregon Utilil$ 19.00
'Notification Center. Those rules are set forth
Permits are non-transfe~able and expire if work is 1AAq!};m.nJ!fJ!C~e#e!l'f(Pfhrough OAR 952-001- ,
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20 I Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsIVolts $375.00
.~econn<;l't Only $ 50.00
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CfuU:ili.jiOn;~(ef;1flbli\~~~~'1l'~~'lJ' FOR
Moo ~~:t~ssERIOO. $ 50.00 .
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
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Address / M ~
City fA1~
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Phone 0. yY ,{,/)...1
Expiration Date
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Supervisor License Number
ConslT. ConlT. Number
Expiration Date
Signarr of Supervising Electrician
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Owners Name \ >1t4K (.,Jt..;h be/V)
Address I 71 f 'L.#--u/n Yf Lv<-!
City L: ~Ii.d-.-/ Phone 7'-h_Ji~" 7
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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Oyer 600 ;\mps,,<;.r 1000 Volts see "B" above.
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
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$ 3.00
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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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7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding'FormsJElectricnl Permit Applicntion 1-03.doc