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Permit Electrical 2008-5-19
SPRINGFIELD ~::::~" ZON \ rl Y ~ ~ ~'- "~"'" ~ Bll ~!t.c.;,::,,,-,t ,;,' "'/ INITIALS \'dV\ ,-",",- --"'~-' DATE' - ," ~ <;' ~ ,,'~,"" 7'h ~'" '\1 - " '.>' I ~l" \ ~;..it ..", ~ -" ,. :Z:Z5 FIfTH STREET. SPRINGFIELD, OR 97477 . PH.(541}726-3753 . FAX. (541)726-3689 ~~~.A ~ "'4 SOURCE ';"(\ (\1 -:>' ') /' ELECTRICAL PERMIT APPLICATION I . / ~,~ Clty Job Number ( ()w1 7..-Cof - oo:S ~ ] Date S / I , / 6tf ... '>j,~ '". l ... ",,,.,__ ~,- . ~ ,f.. ,..... ". ~? j. <..' .. ,~"':i "P"'" 7' ~ f("" '" ...., "... > <f,~ ~ ~ '''~ l ~, N' / , ~.. '" ~ ""t "" ~- f f >~-,- ~ "'~ '- ~ ~ 1. ,:LOCATION OF INST.4iLATION:", ' , 3. ,-' COMPLETE FEE SCHEDULE BEL 0 H'" ,:;. "',' "~;-\:'-' ',' ':.~-' "/'r'"'i'qfM'."";' ""'~-1;t:l.' ,.., ..,.~}:". n.. "-" -' '''-- .,.-4.~_".','-'" ,,- ,'~.. ,"~....\,....",,"', -_:,::.';,:'.:""';.,.,.. .,,;:~~, _, .,'" ~ , ~'~~f~;(~./\ '~l~~h.. ,,-:;.. :'~/r>~1 :7'::....I;...r-"',V;.:: ....t". ,~,""~"~L<(""",'$' . l ~~ - >,"- A. ., New Residential - Single or l\'Iulti-Fanliiv per 'dwelliii" 'unit. - ~....~. '_ ~-_. '" :':,....^ ~ <..... ~!J"":.. -t t-..'."'j.l....!,.,~"h~.~ '"~ '1_"'l-_'->-1I-f",.l:~, J......' -.0<".... '" LEGAL DESCRIPTION. 17D3ZbV3 Ii.{ 000 Service Included 1000 sq ft. or less , l Each additIOnal 500 sq ft or -+-0 t::;x,c; [( portion thereof Permits are non-transferable and expire if work is Each Manufact'd Home or not started within 180 days of issuance or if work is Modular Dwellmg ServIce or Suspended for 180 days. Feeder $106.00 JOB DESCRIPTION ~Jj 3c..I~L~-:t( $ 19 00 $50 00 rl;";l':,"~", ~ ~/ ~<:j~~~~~~~ 'J ~.,.... '\.'t~ ~ ~~~:::...""'^ ",>>,~ ~"~'1 :~~'>' 2. :: ~O~R:~CTq!}'JNSrALLA,TION ONLY' ."".....'" """,, >.J"..l~~, "'" .*","'v~ .....t)~ .,..,,"~ :..,1:..,..~ ..... "" ~... "'.......... ^~~~~~ , ~ 'YO ,~"l\, "'-,' <-"'~../ ".'~,,,~-..~~",,.,J.,.,.: \""''' (^j <.~ l~."j,.~ ,....,~~ ~ ~~ ..f....\ B. ^ Services o~ Feeders:"': Installation," Alteratio'ris or'Relocation: . '1~ < ~~ ^ ~">.~ ~< ".... '","l ~,~... x.~ '" ? v ^ ~ '" "'" ~^"".!,. p~ .... ~:r~ !~~ -...l<' ",' C .;.,~" t ,~_"".. v;:-~ tr 4 ...' , Electrical Contractor Ih .' ~ rf~ ,cCF 'rNv 200 Amps or less 20] Amps to 400 Amps {)1 ~ - (l4... -, eNT\ON: Qt~~ftM1'~~~OU to ~iiow rules ad9{M~ tba~re_JJl!\lty Phone 541- \'Z (llrtflffcation centelerliIOO6EWilrt~Itt~e~_fg~;~ in OAR 952-00HOOWItW~Q& I'd ~ ~ 0090 You may obtain copies of the full;)::. by .. h t~ ~ote' .tlJ~ te}ephcne LI If A S calling t e ~n Or~m Uvill~~b\'rfi~AOOttd~rs . IIUllluer for ffie e , ') Center is 1-800-332-2344 . Installation, Alteration or Relocation 200 Amps or less 20] Amps to 400 Amps 40] Amps to 600 Amps $ 63.00 $ 75 00 $12500 $16300 $375.00 $ 50.00 Address -<) 7 S8' CIty >p~ ,. +1 SupervIsor LIcense Number , . , ExpITatlOn Date Ie v I~'j Constr Contr Number /4(. 74 c;- $ 50 00 $ 69 00 $100 00 ExpiratIOn Date 1- 1~-""9 , Over 600 Amps or 1000 Volts see "B" above - i ' ^ D. . Branch Circuits (";) , SIgnature of SupervlsUlg Electnclan 'L -- -::-:--: /~~-- yC~2' / Owners Name TAI;\A~ ~ -Atl-~-'E I ( (,,14ZtA-, ~ New Alteration or Extension Per Panel One CITCUlt Each AddItIOnal CIrcuIt or WIth ServIce or Feeder PermIt $ 43.00 "3 $ rOO IL 'jtJZ CIty t-u...~E Address E. ~i\~sce~~~Ile?US (S~r~ic~~:~~~d~: Il~t_~~lu,de~) -Ea:~ Installation Pump or Imgatlon $ 50 00 Slgn/OutlUle Llghtmg $ 50 00 OWNER INST ALLA nON LUTIlted Energy/ResldentIa] $ 25.00 The UlstaIIatlOn IS beUlg made on ~ijIW~n w~LL~P1R~\fct~~erCtal $ 45 00 IS not mtended for sale, lease or reiU:1IS"~ERMIT . i~tplE~t*l'f~it Inspection Fee is $45.00 + Surcharges AUTHORIZED UNDE '-nY~r>' ", '. . Owners Signature COMMENCED OR IS Ai3AN\9.',~l'l~:~:'.z: ~O~ . ,_ __, __ / Z .'\N'! ~ PJLllAY PERIOD. I~% State Surcharge I 'It( 10% AdmmlstratIve Fee no 5% Technology Fee .bD Phone Inspection Request: 726-3769 TOTAL /S-~ Shared Dnve(T )/BUlldmg FonTIs/Electncal Pemut ApplicatIOn 8-06 do~