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Permit Electrical 2005-3-24
'- "'.' , ". CITY OF S~ 'lNGFIELD',OREGON:: 'ry , tJ ,~ .. ,- : ' ~ . . '. .. \ ( I ".t/, . Jl'1~ _ ..,. 225 FrITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COW1 W 0 -S -00 s"3 , JOB DESCRIPTION 1000 sq. ft. or less ~).. :-- -;> _ I~ Each additional 500 sq. ft, or tt I-) I..) ..::> C.\~l'l'::::.. portiont)1e~\J\o ~ N reQ\J\re , ii}~- . Permits are non-transferable and expire if ":!lJ;"'~: OregO(\ l~ac\1. t1!'!l~'8t\d\~I\\'l or , , not started within 180 days of issuancp.1iilftNvoHi 'Mo?\ed b'Mb'd'u\~~llillk ~m!ce or $50 00 Suspended for 180 days. 10\10'# r\JleS (\\er. i"cIf&d~r OM" 952-0 ' ri?O~RA.crORirNSTAil.A~}~~~~'\ -OO'? \~lRI!;~\~t\!~~~:jn;t:;ii;"i'ir;li; Alie~iitilihs ~r.Rek;caii~il)\'.1 2. . ,.... ,.,_n~-"'W~~~oiJ'~;,;ho~:~'l~.\'.e'\e~:,r<- ..-".".=,J',.,' ~ .,' -. ",,~hl Electrical Contractor 0 . E.l\\,,~e ca(\ Oreg&!l ~~ ~~; $ 63,00 ~\J1tIO lor \h~ is ,..e\9J.~~~~do Amps $ 75.00 Address cen\e 401 Amps to 600 Amps $125.00 / 601 Amps to 1000 Amps $163,00 City Phone Over'loOO Amps/Volts $375.00 / Reconnect Only $ 50.00 Supervisor License Number C. fj~~mpj6r~t-fS~mc:~s.'9r~'f~{j~7i't~r:;';G'.;~~::::~~1: Expiration Date, / ber 1. ~EO€ATION 6EiiNST]iir'4.tiON.~I;: <''':j,., j , .,'..~ ...." ...,' .. -,-~ ,....,\",.1 / 9 b z.. La.....,......... 6",- 2- -A Ii LEGAL DESCRIPTION 170'3, 2'5"17- Of 000 , Owners Name J/i'>-nJ Address I q (", ::> . ' ?,/I/?~~~ ~ >-a..,,~o,.{J .1:> r Phone 7 V'7 ~ .'5 0"1' / City ~f(r OWNER lNST ALLA nON \ The installation is being made on property I own which is not intended for sale, lease or rent. c!):i:3wr~ ~. . ,,' - ~ Inspection Request: 726-3769 Date :?(Z 0 5 3. !J;Q&~glft~~~SCH.~Q~-g~l{,~9.~'::1~,,)l:<~' ~JI ' A. triW:~[~.~~l~~~~~~~llii1i@l~l~~~-. ~ Service Included $106,00 $ 19,00 Installation, Alteration or Relocation y" 200 Amps or less "I" "1\'\1: '-NO~.,. $ 50.00 _ --(Oll'-c. r .,. I;' I'V . ,,\,,-r\C~o.l Amps to tQ9rAmp's oc\,\\'-!II \ $ 69.00 \\lV \ "1' ;)1''' -LlI.., r c. C\)\'\ LlI'.) I",!-Oh'A:mp.s to 60[l,Aiii.ps "O~I:\) r $100.00 "If' '1\71'\\ \lIW~" tl-Ufl-l-Iu '\.\"I\'\'0ver ~OOJ-tiips.or 100(lVolts see "B" above. " D!:.IWB~b,,".,,,,,."1; .,,,.'"."'41'..,..,:(".'."4" CO ..~~~rcol...."'..:,,..;:"."'f ' f:\~'j New Alteration or Extension Per Panel / One Circuit $ 43,00 Each Additional Circuit or with Service or Feeder Permit Lfj b 2.. $ 3.00 E. F~f.e,Ii..;~~~~.~~hi~eii~;~e.;,~~(fu~l!id~d),;E~~hl'!i~i!~t\<i!lJ Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 , Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges t:~.;...t><._'it _~J::;,.,\_<.(""""" ,....--;.~;, -",-:;0:.' ':';~"Yll -\"~"'J. -'~~ 4. l'SUBTOTAL:OE:'ABOVE(,(i?'"~'r!":,:t,,"':~,,,,~, L 7\..::::-;-~"",A,.:'-",".j,..Y'l','_\;<'i:",-,'jR....,..' \~.{ .:. ""_~r4/i.f":::~, ~(.~ \ ,'- . -";', ~.~.><. . "_'_' ,,.....,,........ ---:.::L," ~., 7 --, (/7 3'13 1.j7o 5773 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 1"()3.doc