HomeMy WebLinkAboutPermit Electrical 2004-9-30
CI1Y OF Sr ~GFIELD, OREGON l)
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)zt~)689
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ELECTRICAL PERMIT APPLICATION I %,~:~ '%"",
City Job Number or D' ()? A- Date ra/20 /Of 0 ..~~ ~.,O' ~.c,"
, ~ ~~
i. & c' "'c &_;
3. I COMPLETE FEY!?~C~D~ B4~~Y
.~O' &. "\. '- br~0~u,,>~
\I'^ "Q" _ -!d';,.!'o.
,";~:::~:~:''''".'~J~~. '"~ ~~:~~
Each additional 500 sq. ft. or /-Z/
portion thereof ' ' $.0 r ,00
""
2. 1 COl'l'1'RACTOR INSTALLATION ONLY I 8.1 Services or Feeder's ~ Install~liol1; Alterations 01' Relocation:
Electrical Contractor BDb Ii. <:;),,,,, rr kc J /1C. 200 A'!'J?~~ $ 63.00
\il'II~IJ\~ht0iO\)/AmPS $ 75,00
Address /?U K'/7Q~~:f~~""~~S~. (\O~ps " $125.00
, , ... ~_..V' C~1FPs $163,00
City Gq~ n e Phone.;.;A O~~ XfWlQ'\fll\~~o1ts "" $375,00
- C e ~ ".....\n cO\l~g'\'i!llilP1P\'\e $ 50,00
;;-~~!Gl>- O"o\ll..\t\6 l\^'iliCa\iO\'\ ,
Supervisor License Number .3 c:; ...,. ~ ,~....M~~~.l:t")' Sen'ices'or Feeders.
......-:' tut\J\ElQl"'cl~2. 'Ex
/ ~ - / - d o~ ~ \9' Installation, Alteration or Relocation !
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
1. I LOCATION OF INSTALLATION
-=1/0 Hc:.!u.Az/,.. ~ CrG".} Dr.
LEGAL DESCRIPTION
J}-v:s 2.3 '+2. eo ':}aD
JOB DESCRIPTION
>f~~ t:,.".J/y ~f4A_(L/
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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.
Expiration Date
Constr, Contr, Numbcr 9h'r2 '76-
jf-
Expiration Date / -",zr- .,Q () t) tP
Signature of Supervising Electrician
14J,,~'-5J :;-~
Owners Name /L,4-R, d V'-S ~
Address 7(0 uA 4Co-,.... '?_ J ~
City S ?I-:::-~
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50,00
$ 50,00
$ 69.00
$100,00
>0
Over 600 Amps or 1000 Volts see "8" above.
D. I, Brandl Circuits,
New Alteration or Extension Per Panel
One Circuit " ~Q.'4-
Each Additional Cin;ui.~~~ ~~,
Service or Feed~~'IT ~~ 'CO $ 3,00
. ' \. ~"f-Y\::~~~ ~(\~
. ~,\\~'l Mi~~~i\'\&':!~der not included) -Each Inst"lIotion I
~ \It.~~~ ~...~_..--
"\~\S ~~~'15 ~1'3l/). $ 50.00
1>-~\~'l-fI~~\l.~ig~ghting $ 50,00
C.~\\i ~ted EnergylResidential $ 25.00
\Ii Limited Energy/Commercial $ 45.00
$ 43.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.1 SUJJTOTAL OF ABOVE
327
2-2:~'7
~.L...l:....L
~z;:, ?_O
i! '382 ~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding FormslElectrical Permit Application l..o3.doc