HomeMy WebLinkAboutPermit Electrical 2005-1-3
225 FIFTH STREET · SPRINGFIELD, OR 97477 . PH:(541)726-3753 .l!;~$~il-J.l26-3689
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ELECTRICAL PERMIT APPLICATION Ol/iil 0' %;01(';0/ CJ
81) ~8
CIty Job Number CO yt.1 Z <::) () '-t - 0 I 7- 7 g Date 0iit., <01) 0; re vbtrJlt.
II){) ((vir/,? "leo'
4uZ!J.c.~' "9 Sf) I,ils
3. COMPLETlttglJ(fi. S6HED LO~ :1)$101/.
.s/~ ill'}(f olit/.'f}
&I)iif ;' " 3 IISf' ' .Ie
lire _
" ~
A. N C1\ Residential - Single or''M~. ~y pe
Service Included ~l!.,
"
""$,106 00
1.
LOCATION OF INSTALLATION
:3.3004~-+;
LEGAL DESCRIPTION
1'703 22-20
JOB DESCRIPTION
"'5>1-
OI/dU
1000 sq ft or less
Each addItIOnal 500 sq ft or
portIOn thereof
/ ~~ ( 2-) ILL. &oJ"'" LUAu,.. ~L"~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Each Manufact'd Home or
Modular Dwellmg ServIce or
Feeder
2.
CONTRACTOR INSTALLATION ONLY
B. Services or Feeders - Installation, Alterations or Relocation:
New Alteration or Extension Per Panel
One CIrcUIt
Each AddItIonal CIrcUIt or WIth
I J " UOTICE~ervIceorFeederPermIt
Owners Name Nw6Jt\o'f'E ~ l't, .
AddI ess Btfo g ~ N-(:::,~ .:tJ::: '2-0 2-Hi I S P ~ r'1!Ii~~f\Jn~J.~8f~j;,lfeiftl~>>'RJ1lfncluded) -Each Installation
AUTHURiZED UNDER TH S PERMIT !S NOT
CIty Sf71U1\l"nd..O Phone 1%- SCf~ttC)r'J:I\lEr..tGfl1i1 ~ahi3d-NlJONED FOR $ 50 00
'ANY 1 b03j~6lliIliH8f1.ghtmg 2- $ 50 00
LImIted EneIgy/ResIdenttal $ 25 00
LImIted Energy/CommercIal $ 45 00
Electncal Contractor
e~'t-A- SlbN AJ.,lD ~/~C:r- 200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Phone ~'S"... ~1./ to A TTENIDk@NI:em9~p,s(~~lts .
follow nme:s:>~~~ reqUIres you to
NotificatIon Center. Th Y the Oregon Utility
. 0 . OSa rutes a!:Af f ...&..
In AR e52~~foYt~f6ulc~ JlrFe"el}@rsO,uf
\>090. You may obtal'n 9 uAR952-001_
COpIes of tho It:> hu
CallIng fJJr,a41_e, (Ner&tl~n of KeUlL'ftiitHJ'
"umber !<0otmhfiM..",,]A U'., e telephone
~Ar_~ ~ 7~ t/hty Notlf/catlun
.~ t\ll@~4).
401 Amps to 600 Amps
Address
/2-( () "A-7LP-t'RH )2...f.)
CIty li.-u f::,.1:!:PJ cC
SupervISor LIcense Number
3DS"~l6r
ExpIratIon Date
lofo5
Constr Contr Number 'L/5:1sr-
IPI~D I ()16
ExpIratIOn Date
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
:l~~"1Cc~
..-/
OWNER INSTALLATION
The mstallatlOn IS bemg made on pIoperty lawn whIch
IS not mtended for sale, lease or rent
$ 1900
$50 00
$ 63 00
$ 75 00
$125 00
$16300
$37500
$ 50 00
$ 50 00
$ 69 00
$100 00
$ 43 00
$ 3.00
/uu-
Owners SIgnature
N/A-
4. SUBTOTAL OF ABOVE
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
7% State Surcharge
10% AdmmIstratIve Fee
Inspection Request: 726-3769
TOTAL
3hdled DmelT )'BUlldtng Fonm/Electncal Pcnrut AppllC<l110n I-Ii] dOl
101>-
'l-
It)-
1/7-