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HomeMy WebLinkAboutPermit Electrical 2005-12-30 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 ELECTRICAL PERMIT APPLICATION City Job Number CO.v..zoc,o;"'- c> l7s? ~: 200 AIIWp\\5, ~'f 1HE' WORK $ 63.00 /-1\'115 PEP-Mli 5~~1,..1\~ ~,'l\ll'S\S N01 $ 75.00 'Uiw:w.11ED UNIil~~ ~Sill.QrrPfOR $125.00 / COMMENCED 06'\JI~A s~o '(000 Amps' $163.00 )orie ., ~I)Di\~ V~w.Gi~60 AmpsNolts . $375.00 ~, Reconnect Only $ 50.00 r.;"~..\,:::~'r:-.~ ,,~,~""1'5, ;.::t'7'~ ~'!-:'";'""',t:-;'~"0"~~~;,-';- ',l".....:.:.~..., .;~ Supervisor License7u ber c. ;o:':Temporar\'.Sen'lccs'or Feeders'>"'f,:\ - "\>",', ';;,>flf.. "';:.. _....''..~.l' f:e , ~.:) f',""'4'''''' ;;.J:-';'.,,,-,,'_'-.,,,: '''~~.&..:..''''j\,o.-",/....:l.''''',-.I'~~....~_l'I.,..;.~#''''~J,;.../;_..",:......~..:..;",: Expiration Date Installation, Alteration or Relocation / 200 Amps or less constr';Zcontr 'Number 201 Amps to 400 Amps 40 I Amps to 600 Amps Expiratio Date Over 600 Amps or 1000 Volts see "B" above. Signature of Supervising Electrician D. ~:]i~~~I~i~~~jt~~~~]~ ~~~;~~~{~3if'~~~~~5':r(Z1,:~~!~~~1:7'1.~~~~~ ..,. '.' ". ,.. ~.'),. H .. '" . . :..-. '_ ..' .'~ \ ' . + I. \ {OCATJON91; INST ALI-0-pON.: 1<..~':' ; qOfmd1YJsf1:ad''''Sr'' LEGAL DESCRIPTION {703. Z-s.3t{ DbCOO JOB DESCRIPTION :Jfl ~klwfl7l1j/e'-d-kr~~&c- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. l ~"', ," -", . .. fi<: :}' ,. ""'.. . '. """'! . ~,., .,<: ':.~-"";::""T.'1,.~.-;..t'" :' ~; 2. ~ C9N1~P'Of INSl'A.LLA'!lfJI'fOl'flcy'., __ ~,.'I...c:......!"~_, -.<'. ......... ~t.+h,""O< "~"'''-'''''''''-'-'''''''''--;.(;:.;::''''~ Electrical Contractor Address City 3. 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $ 19.00 $50.00 ... ,:;..tt." . ;"''t,r:: t 1'6'.::....,.\.. i?)',,~''i;'i:~~ .~:Z3i":;:i.":t '~":'!>~~"-:-i?'~:: }[-';(.~;:- ~::::,~<-:; ;-,~..-;:;";::J B. ~ :~~~.r.".i~.es~~r. 'Ft'ede~s,_'~':'" >.1 ~,stal~.iti~~;:~lt~~ati~~s '~i~R.~.~oc..a'tio~:~~~"M + ~,_,_",~'\_~'..J'_ .-~.;..;.I..._h~~.J:.~...,.....';';;;._ _.1...t... _..!.'.........,...... .:.Jo.rJ._.:....:J $ 50.00 $ 69.00 $100.00 New Alteration or Extension Per Panel One Circuit i Each Additional Circuit or with Service or Feeder Permit $ 43.00 'I) Owners NaCh tA12 k- > C 0 '-I ".,..-- .h.".... ....: ~'7".,".., -;0-"' ~,.,~",.~",.~,,,,.~,,,,,,,;,,-,,,"\....~,,,"..,...-.~... ;.' .... ',~~.~ Address l/() '{ //l1f6n c,.-h:'-: (cf" <; I E. ;l\1i~c~ii'a~:eg~d~e~v!C~!feJde;:notj~c1~de~i:::Eii~hi~~t~I\~ihin; . ,_' "T.Q:... .....~,~ '\avtreqL1\res.)'O~\"'~ -~--"' <;.\ -- .. -"'~, '......"Il',,-. -4- C. S r \ C( Ph ,L~ I - rf.~/~~'" ("\,,,aOI1 0 eg0I111t\\i V $ 5 Ity'l-" one '~]) '/ Ia ^ ~l;'ump or 'rngat1on tne I . <_,," 0.00 / r- 1--' . 4r:~tt::O uy are S-oL ,_. \ \10'1'1 IlSign/0utline Lightingru\es __ ",,1. $ 50.00 TO. .n (:"C)f\t~r. 1 \ .\J~~ .\_ t:"\,t\R 9':;t- ~- OWNER INSTALLATION Noti\iCati'!!.,m'ted Energ3'l/}~de.!'t,al' .,_~ hY $ 25.00 /) ng~o.(101-UU' _,_~"ftnel,*.- The install (,on'is being made on property [ own whichil1 OAn b,mltea I{,'\5[w/AoD1mercial \er",,,,,e $ 45.00 6A d d' I I . r." vOUl11ay ,,,,,,Ie.tnete . . IS ID e .or sa e ease or rent. OO:\\1~~~~I~.~:~~.e~;~t,O.}..~.~rf~.~.~;~.~I~. _45~n..~.<.>", urcharges ~ Ow . Si nature' I1d:n~~U~TO:Z:-1!', Q1.l~~"':i':i':" :: .~~} 0: Cf .) - .centeIJ.... . .,,' ~-- .......,.-.... .. .., ....... 7% State Surcharge -:J f r ~ lO%'Administrative Fee l( rc Inspection Request: ~~769 TOTAL c::;: Z ~ $ 3.00 Shared Drive(T:)/Building Forms/Electrical Permit Applicalion 1-03.doc