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Permit Electrical 2004-10-15
225 FIFTH STREET . SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX: (541)72;B::~~/,,: ;0 &> o~ ELECTRICAL PERMIT APPLICATION, ,"'ot.-<$' <$'" ~ /' 0 fO/ / V<$' /' 0',0"" City Job Number L-OH1 7-0-0'-1 - 6/ 7- 7 '" Date I ( S /0 '-\ . I'~ ~ OO~ g,~ -" 0 oS' C'~ f .~ ~ " '<$' 1. ~~LOCAITON3~F PjSTAf:0170!Y<: ere~: ~ 3. ~ ~O]ltIPLE!i f~~ S2~f "~" ~~6:~~,. "'C"'/""'o. 0 /'. / --L ~ ~<S) '$ ::>..:;-' Ln"'--n=""" ~V' ~,- "<$' ~ e ~ O'~ LEGAL DESCRIPTION I' A. New Resid~~ltiat :.. Single or'~Tt~" ti- cril~ er~ i';~..UJ~it. e '" ,~ " ,'..'.. .. C' ><4'''\V'''Q'~b{,~ ,22::0 6aA-T'lau~ RL.&..J;) Service Included ?t G-<l'<S) ~"'.9 JOB DESCRIPTION 1000 sq, ft. or less 06 ItJ5.~ lu.....J"1.. 't)o"Bt.ee ~ Each,~?dltIOnaI500 sq ft. or '" :': ~ 5.1...,..J portIOn thereof ~ 0 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 $5000 Suspended for 180 days. Feeder \0 2 ;:CfjJ;VIjiAC.T9F INSrAj..];ATION ON~Y'~: ~~u\~1;t~~\~'tie~der~ ~ I~st~ll~ti~n: Ait~rati~n~,~(R~!~C~ltion: . ,,,' $'" -"'",,--, ,HH'Y ,,,' ,<, ' '" \'a-\t3 O~~~"', If~\)"\ ,,, ,," , " "-"",".,":; " ~~ ~(: 'a~0 :,)~')e()\J - Electncal Contractor ~~A- 61~r ~ l} ~Ililfl); or l~s~'i $ 63 00 ~60 '-'OS ~pi~- \\\\) ~~':u\es~ ~ "\,\ O\)~V ~fl);\t040QjAmps $ 75.00 Address I~to ~p h O~f'ce\'\\~~"{)\~~O()~OAnWf-t~~~g\\nps $12500 ~ ~\V' ~\;,J . ~ C 'i" . '5..'0e ~\\V'" ~'i..\~\C~ o'2:fj 0'O\'a-\ ~o'l801~~~ 0 1000 Amps $16300 City eu.~(!; Phon 0 'tJp.\e1. 90~~2}1J1:J~l>, mpsNolts $37500 009 '. {\9 \\\e \~e O~e CO\)~~onnect Only $ 50.00 ~\'\ ~\01 \~ ,,- Supervisor License Number =3oS" ,:>~'Oe ve\,\\e1 C. e:r~~P?rary);eT~i~~s ~~"F~~d~!s. /0 ~.:;- ExpIratIon Date Ie "- '< ~"" <; Installation, Alteration or Relocation Constr. Contr, Number 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69 00 $10000 l ~S'15C fol'.Jb 108 Over 600 Amps or 1000 Volts see "B" above > ~, ,,%i' , , /., .v' X J ' ty' < s;gnzre o:s~mt~ttirr . D. ';e::::'~::~:: Ex!e.,;on P.. pan~\)",ii;" 0". ~ ~~V^_...\._ "_. __ One CircUIt ~......~K:.\,,\\\~\~~~43.00 - Each AdditIonal ClrcUlt,..~~~u( t.~~\ \ \)~ Semce or Feeder.Rerlnrt- \\\s \l ..-(\ 'X $ 3 00 Owners Name ~~ "bl:!v'~~~~ \\\.~",~~\\ ~\\\"~\J> \\'t\\'\\)\)~~-" , . .. Address 640 Ba..:rL.4 Nt: fZ..D ~ E\'~lJ~~~~~(lN~r\'i5~eder not includedf-Each Installation \'f\\~\\Zj\\\c'':I\) ~X' i\\)\)" ~ .' ., , " e City ~p(L.'~~cu.D Phone "7~';>~ fr\I'f-'"I P1.Iihb~~,f\~~\~{ \l~ $ 50 00 .;. Slg~~lUfce~ightmg / $ 50 00 5b - LImI~a Energy/ResIdentIal $ 25.00 Limited Energy/CommercIal $ 45 00 Expiration Date -:;< ....''; OWNER INSTALLA nON The mstallatIOn IS bemg made on property I own which IS not mtended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature. N. ~ ? /j 4. SUBTOTAL OF ABOVE ., Inspection Request: 726-3769 TOTAL Sb- 3.5lJ 5" .fn) Sf.S[) 7% State ?urcharge 10% AdmmlstratIve Fee Shared Dnve(T )/BuIldmg Fonns/E1ectllcal PenUlt ApphcatJOn 1-03 doc