HomeMy WebLinkAboutPermit Electrical 2008-4-30
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
CIty Job Number CO""", ZooB - 00 Z 7 3
1. LOCATION OF INSTALLATION:
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LEGAL DESCRIPTION:
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JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
ZON
INITIALS
DATE
SOURCE
Date if... 36- olf
3. COMPLETE FEE SCHEDULE BEWW
A. New Residential - Single or Multi-Family per dwelling unit.
Service Included
1000 sq ft or less
Each addItIonal 500 sq ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling ServIce or
Feeder
$117.00
$ 21 00
$55 00
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2. CONTRACTOR INSTALLATION ONLY B. Services"or Feeders - Installation, Alterations or Relocation:
J ' r- I rrrNTION 0, P."'nn i;:u...._raq" , Aa"
Electncal Contractor .........t'"V, GCi fA l-.4-f' ~.R~ 200 ~s (5rll;;::;~ lIJres YOU...
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Address .38qq- ''i<CbQ:;ueL-I- I.~i U~~-\:j~1~~f.tg~1~~9~~_~~
u090. You may6Rh~WPM'P~sog?t~srules by
City C:;(D.?'/d. Phone 9v'-/~g the c~r.1~~hte?liNJr~~prwn.
IIImber for t~~h <mlnty NotlticatQa
~.J Cente. IS l-aoO-3322344'_',t
L 7 g ~ S c. , Temporary se~ic& or Feeders
SupervIsor License Number
EXpIratIOn Date
/0/61/ :'+0/0
/7 ''583)
/ ~ ./3r-~ ,/rl-cYJt.
Constr. Contr Number
ExpIration Date
Signature of SupervIsmg Elec~~
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Owners Name J "'" J~v
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ST>r~
Address
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City
Phone
OWNER INST ALLA TION
The installation IS being made on property r own which
is not mtended for sale, lease or rent.
Owners SIgnature
Inspection Request: 726-3769
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 V olts ~ee "B" above
D. Branch Circuits
$ 70.00
$ 83.00
$138.00
$180 00
$413 00
$ 55.00
$ 55.00
$ 76 00
$110.00
New Alteration or Extension Per Panel (
One CIrcuit $ 48.00
Each AddItIonal CirCUIt or with ~
ServIce or Feeder PermIt .V..L.r..$ ~.~ /"
'omB-\M t"" \J\I\-~\. .
" '" - n n~:lN3IAl\f'm~1
E. MisceVM~~~nf!~~&\-\1bt i~'-~tM-1!fl~ Installation
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pum~Qt'llii :itJ~h ~13~-11r1'X3 ll\-lU~ J n'~~1~5.(),ON
SI~lli\ ~tmg . ::r$"'~5;.l)6
LlIDited Energy/Residenhal $ 28.00
Limited Energy/Commercial $ 50.00
Minimum Electric Permit Inspection Fee is $50.00 + Surcharges
, <2
4. SlJ.lH vTAL OF ABOVE .../
bz'r
12% State Surcharge
10% AdminIstratIve Fee S"Z. ~
5% Technology Fee Z bO
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TOTAL
Shared Dnve(T )/BuIldmg Fonns/Electncal Pennlt Apphcatlon 1-08 doc