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