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Home My WebLink AboutPermit Signage 2004-11-12 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-36fiJ).~~ ELECTRICAL PERMIT APPLICATION /, :~.:/ ?e,~~ . "'/"~~ City Job Number COl+\'Z-Ool( -O/~7lJ Date /1/0 '1/0'1 ." ,~~~:<~,ec. ~~~ (( ''I<&L~(-:S:::_ J..:4ibt,., 3. f.:.2(jM,pEiflj;-j.,#'E scjlwj'~ffB~i9~~~.T~':.~~~~1 A. PR~}ie;ide~iiaI-;~iilg!e~F1\~~ r.dW~I!i~Iti'iijti~n New AJteration or Exterision'Per Panel One Circuit $ 43.00 Each Additional Circuit or wi~__tfl\ S~I~___-"~3.00 ~;=~~T.~~~~~;~i~i~\I~!J~~ ' ltPQM,Il~'\>~btaln copies ot\h8 ~,.OO OO~O~~~~. (NOte: \hflUll".r~"O.OO 510. D~ L~~tipi~~ii" UtIU~t $ 25.00 . LUDlted E'lSoo'I'~&fi9f332 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. FsViiTOTAi-}6F.'ABOVE':J~~i ':;:.'~,\?~:;'~ ~ . o~ ~~~_- ." ...... .~. - ~:1t_~ -. ,. .-.-".-~.;..J! "", J . , ~ \) 7% State SI,In,l1axge____ - - -- '3-' ',o-~~ t\~~ 10% Administrati\'e Fee oJ ~ ~~\O TOTALR8.~. O:i r!t:J Shared Drive(T:)lBuilding Fonns/Ele<:Irical Permit Applicatioo I-OJ.doc . :....1~-;.-...'~..~~-~~-:--_.._-"":""'----~;r:-:-:'"-.. I. t;tOCATIONOFlNSTALLA1'JON...... 1... ." ,,'." ',... '. ....... ." \ Sb L.J n 1'YlL1..L n &.;t:- LEGAL DESCRIPTION 170Z. 3'3'1/ JOB DESCRIPTION OJODO All/rw\ (~ lAYh./) Al (d S I' C, IU Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. nCQW:R.A?I()~:0!,s,t&:0n:ON ()14Y. j Electrical Contractor~ ..4-i ~ :iSYbS .~<.. Address 3\ b S' C.ISn1Yl'1A.Ac.U.J..!::.J:. S(. City ,<a.l~ Yh Phone5Z:l3- 3lolJ . cl~ II Supervisor License Number :3Q q - S ,. (.., Expiration Date ~S; Constr. Contr. Number fc47101 Expirati;n Date ....3! 0 &, si~perviSing Electrician ~~~ / p?zlE ?/1"a t-tIJ I....\..-<- Srll.Nv- ~Nt.I Owners Name YSwtl1Wl (2... Address "3 Y 7 /,/ City ~1A bd~/VC Phone OWNER INSTALLATION The installation is being made on property lawn which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $ 19.00 Il.. Each Manufact'd Home or ~ Modular Dwelling Service or $50.00 Feeder 'i~~fJ;~eS~ilr,.r..~~er;f~fu~i"'i$iq-ji(~11611;~; Relo~tiOli:,.. ,I lHki_t!Ch.ML.L~1;lf\'t:l.:I^Il.,nT:. ~",." ~ .r'l, ' ,,-'~f\' '._ - l1blnR\ZED UNDER THIS PERMIT I~ NU I A\.!lUO')!JDI1~ ?bl~ IS ABANDON:':' ~n~ $ 63.00 CGM~~ ~4 M.'l5 $ 75.00 A~~I wrp~ ~ 6 ~ps' $125.00 60 I Amps to 1000 Amps $ I 63.00 Over 1000 AmpsNolts $375.00 Reconnect Only $ 50.00 C (T'.~I:;. ~.~...!. "o'''':''S.. ~1.'<::.~;:XU1i;l;+'f.~.*F:::'iX~.I"'T.!'-'t:~.,'. !;';t'~:1i?:'~}Y.~#i";-;t'+.b'.,-;;:;' i:'rt'\.;.t.+'j _ ',', ~_~p~,,~r-~~f~._e~~l.~C~~.~.ri' .!~,~~}~~\~~,~};~p>:.::;ry~::..~{."A"";/-'l.-:l:::-.~u Installation, Alteration or Relocation 200 Amps or less 201 Amps to 40.0 Amps ".11" 401 Amps to 600 Amps . \~I $ 50.00 $ 69.00 $100.00 Over 600 Amps or 1000 Volts see "B" above. '"'.' .....,~:.*,'J.'< 'I'''-;'.l,:;.~~':<~'^'~.~~. "."." ""."~ff''7;",;;~,.. ".~'1,;I{'~"""""J~.{t?....,.t):Jw.lli..'-....,y-n:Ar:." 'A..LI.'.'~-"'~ ,.~~ :.~.~ D "'Bl'anch f",rcults ", . ":"""'\'''''''''''\''~ ,'_'M,"1i\"'t\S0"':', ""l\!,brK'''-'';' . '~"""\lr".:ct.., :i""..41 . r~....,'. .~" .l"-'!: ~i'i":;>c'r;;fk'.&',i%,r~~(*f 'l?i',1S"6J'h:..1 {'.~~w;.i~,,);,"~;;J"k~ L..:oo...,,~' .,.,'''>''''-.'n~.,.:.._'''''': 'oll'-'" _,_.",,,":,,, .-. ,', _ '~~":;'''0;:.. _~ !~~. g':""" ...... ... -"'.. .,' '",.