HomeMy WebLinkAboutPermit Electrical 2007-4-27
ZON
INITIALS
. DATE
SOURCE
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX, (541)726-3689
ELECTRICAL PERMIT APPliCATION
City Job Number ~~'1- 0111> !DO
i.//:J..7/0'T
Date
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1. ...LOCATION OF INSTALIATION,>J..;.;<pr,
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LEGAL DESCRIPTION:
17 0,," .5'/' 33 OA..~
JOB DESCRIPTION:
W,~~."~;_~11:;r.:~I'\1:'7r..:::r;.J rj .-,'.'....,. :;:_ ~;~~'!?1tt~~~~tr.'~,.::.::;7:.7J;;
A. r!Ne\v Residential.~ Sin'gle_'ofMulti':FamiJS:-:-per:-dwelliIt'g'"uiiit.\~~~:-~
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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
$106.00
\faJI~ ~b~ .. . .
Permits are non-trJ,\sferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$ 19.00
$50.00
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B. ti~~lt~~~~~;~,~~~~f2:~~J1t~~~lli~1\~~~~~~~~~~~~&l~~~22.:,~l
~!~~.'\r':.:m'.,;'-::i1'~::'t~!.;mif~"':t~.;jf"}:"5'r~m1:r.'7,~r::;,;-1'Si
'.;CONTRACTOR'INSTALIATION,ONEY,;i,
2. 1J~t...'~w.;~.;i.tl~~'..~V:::k~:3"""'~':o:.~~';"~""''''''t-~;~t.-:~...., ~;'",
KtJ
Electrical Contractor (! 1~ H/ T;t /J
f)}. iJo'X. 'ife
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
c;r o;~- '2. ?~;r- Over 1 000 AmpsIV~lts
Reconnect Only
Address
City {J A6CtJ ~ t.4hone
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.C. it:Teliip' orarv ~. ervlces'or~Fee(jers:<-~~'~fi,~':;..'>;~~ ~~~;f;jf~iJf::'~').~J.~;,~~,,;:{!4:..:);/,1
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Supervisor License Number
Installation, AlteratIon.or Relocation
200 Amps or less
20 I Amps to 400 Amps
_ 401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. r1B~~~ti:cii~fji~fi~!$ftjt~~~;i~~g{~~~~;t;;~~~~@~~~~J~:ft~~
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Expiration Date
$ 50.00
$ 69.00
$100.00
t /( 9~t1
Expiration Date "y .- I f1 - cJ 9'
S;-~7Pe:;$J~
X/ " Vv
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Constr. Contr. Number
New AlIeration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
Owners Name
E~ ~!lt~!ti~~P~;~;j~~~m7ia;;~~!i[~~rt~~~li~~
Address
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
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4. ~SUBTOTAL.OF:4B VE;';"""r~c~.i.,";:r',!"X.;,'", 'If' '70. .
~f.;.~.Jib.lii'~~~-.:l>"'" "~",..,~,-.:-,,,.T~,::{ru:.:i.;;.t.t.u;:r.r7:"J.
. 8% State Surcharge
I 0% Administrative Fee
5% Technology Fee
Phone
City
~.-
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
:~,~
-f..!>7)
ol . a.s-'
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TOTAL' 6<:; . 030:.
Shared onve(T:)lBuilding Fonns/Ele,;;trical Permit Application 8-06.doc
Inspection Request: 726-3769