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Permit Electrical 2004-11-3
. ' .~i~ 1i.....~1 ....111111, . :t;rr , SPRINQFIELD , 225 J'lHn STREET. SPRlNGFIE. LD, OR 97477 . PH:(541)726~;753 .~: (54J.)726-~cl ~.. . ~ . . ..ct"" 0::0"'. . I)oq.s'~~ ELECTRJCAL PERMIT APPUCATION. . . >jo, "'.. . I,.. "'06' . City Job Number (;j:) WI zOo ~l - 0 I z- b ..;-. Date .....0'.0. "'-.. 9Q/~..~;;'..~ . : . ~ 0~ . '10 "."- "o."~ 1. !\!"mc.rTION:eE1Ns~rro~~ 3. ~corr;;-"-:;'.;.7itEEis{:#iill ,?-1'":.'" ~..iii''''''''''~-''~.~~~''t;;~'''''''''.~'4'.'_''''-'''~ ~,.-..,-,,-_._.~~,...;\:rt"'Y,d"'~"-"--""-'-'" -. '. ::~:~:;: ;:'DO &~~~ Each additional 500 sq. ft. .or portion thereof Permits are non-transferable and expire if work is Each Manufact'd Home or ,;C not started within 180 days of issuance or if work.is Modular Dwelling Service or Suspended for 180 days. Feeder ir'.~'~'-~f.;;---~''''''1;'',--~ .~ /'~ m"'..llf~"'''~''~:m!i"""x_'''',~-'''="",:~m~~ 2. i."fg,,~~~~-~~~ /,,'. ~,,~~t\f,W~~~~~JJr,,~!~~J!~~~J!c~ f Ircw vit'o 0 'vI) fill I, ' r('J Electrical Contractor i~ 'It/Cat/200 J\mPb or ~ I" $ 63.00 OAf? un G ~t&^^ "W, 009 95~1Ifu1PJrto~fffl'pseqlJlres $ 75.00 "a7: YOlJm?~i3~~gsOregO JIolJ~ $125.00 f1lJtn~"g theaj}' ~4Jfi 'f!!Jiif/11 ilre ';;:tl/ih. $ 163.00 ar IOr9~~~ ~9\)', ~.q 9so? yo~ $375.00 Caf1t~~~tp: u'e the fl/A 'QQ'o $ 50.00 rla,~ tete 9sb'f c.~oi:a._. ~~B~'" Installation, Alteration or Relocation 200 Amps or less , 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. NOTI0l:.l@1'i'ii~~ftdr~~_~JIIJ I~IS PEAA~~;~r:f:-o~Extensionper'panel ...... . ~J THOR/~ ~'1~R ~P{RE IF THr: w- J $ 43.00 L.J ~ v MMENL~fPtMili#dnrta;!fQuftlormtli ~ 0fA-rr ANY 180 d1fr'i9E~t'f;ffi;'rlfE,wiE~ FhS Nnr . $ 3.00 A r;.~"'~"~"'~J""'-~"~$~~~-''''~'~''''~ t1? rrrlD<L ~ (L E. ~~~~ii~.k!~4em~!lJ.;.!j!~!1.!'~ia~~~),;g:;~.~@!a'0 .. Phone 74 '7 - 'i? ~ 00 Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResideptia! $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges ~~,..,-c""~",~:;:l;I";'.t~~~./:":~,...:,..~ 4.tfSfJBWTAI70FABO .. ~~~~.;'iij~~;j;~;~~';:;"':?~~,~ A::P,) I c-\ fLc..'^- --: +- $ 19.00 $50.00 Address City Phone "',.,.;-"",", N.... ~ ~ Expiration Date . ~\ '(f Constr. Contr. Number $ 50.00 $ 69.00 $100.00 Expiration Dale Signature of Supervising Electrician Owners Name iii !J-fLlL Address '2-7/'1 'SPf" ~ City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. \ ~ . Lis -'Y5 '150 t)2~ Owners Signature: /rla.1C. 7% Stale Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared DriveIT:lIBuildinll Forms/Electrical Pennit Application l-Q3.doc