HomeMy WebLinkAboutPermit Electrical 2006-8-2
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SPA'NGP'ELA
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (541)726-3689 ~. l
ELECTRICAl' PERMIT APPLICATION ~ ~ ")""j...tJJ ') 1l7l/'~
City Job Numhe.(arA7 ~ Dat 'L )/ d If?' V U'f"
I. I LOCATION OF INSTALLATION ' I 3. I COMPLETE FEE SCH D - BELOW I .
Vi.dd:-~ LA h,)(\ t1JCi(l{L--..,^ ' "*
LEGAL DESCRIPTION 0 A. I New Residential- Single or Multi-Family per dwelliug u
1103 d5 ;:} In(P I crD Service Included
JOB DESCRIPTION 1000 sq. ft. or less n law requires you to. $106.00
~ ^ J.,.. () A"!O~~'iilI(jjfi'(jna'jl5861~q-till ?fle Oregon U\lIIlY
\\0 (.l.:A \.U ~ 10p.ortion,thereof10pteo, les MP. setlort~ 19.00
,IV" ,~.. lhose ru .
\ ", "~n Cen\8r. OAR 952-001-
Permits are non-transfera Ie and expire if work is NOEach'Manufact'a)\i~me\'1rough
not started within t80 days of issuance or if work is in i.MQOul.at~~'lli~g'SeYv\c~orles 01 the rules bY$SO 00
S d d' 180 d F d may ootaln" f' . '.r-~ .
uspen e .nr ays. OG~"rJU . . L1Note: the It''',,f'''-'''~_
I I Ga'lIll\ \ ,\ ,,, cente 1.I""\1'd,,ol1lica\;lO.
2. CONTRACTOR INSTALLATION ONLY B. i Servit"fu'l,\f,~ilS(alla... ~'A~lterations or Relocation:
n\:lmoe . 1 l:luu-,,32-23......
fn D.. '-T- Center IS -
Electrical Contractor I' ,1\ 0 2. I ecA",c... -LV\'-.., 200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
fIor+-hN'c:\.c;e ,,~~ 401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 Ampsl,Volts $375.00
Reconnect Only $ 50.00
'rlf'll>1~r1 J..VC1 \In ^I"V
c. I Temporary serviCj orJFeeders,nL n\ "0 C1J~'Nl\~!I"J\l: 1
B" U \..... ..... ~,. -, n
. _" ~ IIIW;;;C:1HL mONn Q3Z\\:lOH1II\1
Installation, Alteration or Relociltion:lllVH5 llli\l\:ljd 51Hl.
200 Amps orieHOM jHl:l\ j\:lldX $50.00 :',"II1m,1
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $ 100.00
\ I I 1
a eIT'{ ()1'':-lI'RINCirIEI.D, OR[GON "-...J
Address 9 s 1
City ~ld
Phone ~ /t;G;OI
Supervisor License Number 4- ~ 7'-f S
Expiration Date / c/o 7
Constr. Contr. Number ;:;lO- ,"'IA 7 C-
Le. e, I&' :?-.1'11
Expiration Date / ~/;r{)C<.
Signature of Supervising Electrician
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'ii-,
Over 600 Amps or 1000 Volts see "B" above.
D. I Branch Circuits
I
-<,e _ (JIJ
New Alteration or Extension Per pail
One Circuit
... Each Additional Circuit or with
. ~ _ ,,_ _ I ~ ) Service or Feeder Permit
Owners Name LY CJ TI NrOU/V
Address / ~<;tY' ~/'J IZ<.d ~ ~ I Miscellaneous (Serviceffeeder not included) -Each Installation I
City~j rJ./V Phone. Pump or irrigation $ 50.00
(j" Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited Energy/Residential $ 25.00
The installation is being made on property I own which Limited Energy/Commercial ~_ ,~ ~O
is not intended for sale, lease or rent. Minimum Elt(tric Permit Inspecti~e is $45~rchargeS
I .!j5 em
4. SUBTOTAL OF ABOVE I,;;) :;;;5
3 .(bo
-,-/,5Q
Ji ,e:::;") ,~5
$ 43.00
$ 3.00
Owners Signature:
8% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding FormslElectrical Permit Application I.Q6.doc