HomeMy WebLinkAboutPermit Building 2002-4-8
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ELEACAL PERMIT APPLICATION
cily Job NUlllber (J.2- OO~/ - 0/
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
*
The following proiedasGlilMli\l>li:ilB r~Iio~JliDULE BELOW
I. LO<;A nON OF I.NST ALLA Tl0N"ng ana doe, not ,equi.. specific land use
:J I J V YV'\UAV, "iLr LJ'ilp,oval , A(l'I~ Residential-Single or
J Zonmg _' ~ f.1Hlti fBfRilj' per dwelling unit.
LEGAL DESCRIP~ION 0, ale Jf-<{ ,iJ, -:r- \ Service Includ~:
11.0."i',"i/.. 2. Ol.'100 _ O')J Items
~ '-"'-"-"''' .:ngnahHE::
JOB DEScRIPTI()N I . AnENTiOI ',_ , 1000 sq.fl. or less .
~ lAU.-<.1L f~lIn"'rul .~.OrE::~Each\additi,wp~500
U NotificatiDne~ adoptesqbjl t1ffPl!l1ill3o~~~/~
Permits are non-transferable and expire;n OAR 952 0 enter. tlitnefru/eS~'i_S~J f~ y
if work is not started within 180 days 0090 y, - 01'00103':ill1!l~1'eJ; ~~(j(rth
of issuance or if work is suspended for caliin o~hmay ObtalMoI!JV!!!'g:ny~ m~O I -001-
180 days. 9 e center. ~~~bli.#1[tU es by
numberforthe Oregon uii/;'t I .~no~e
2. CONTRACTOR INST ALLA nON ONLY CentrJr iSei-YlCe}.g'<J~ifiJitlflcatJon
( 1 {' El ~ InstallatIOn, ~1terations or
Electrical contractor_.I1u eCTYJ'c,..Lrc.. Relocation:
Address f. o. flm lL\.<r 1-
ci~pYi~R(ldphone t4-i-~c:'
Supervisor License Number ~4-~
loll 1m
constr contr. Number ,~~
q!l/DJ..-
Cost
Swn
$106.00
$ 19,00
$ 50,00
Expiration Date
200 amps or less
20 I amps to 400 amps
40 I amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163,00
$375.00
$ 50.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
~?
. D. Branch Circuits
Owners Name ~~t~, L EXPIRE IF THE WORK
AUm6RIZED UNDER THIS PEA'Wlrr~'MYfn or Extension Per Panel
Address ?D. ~ ~D OR.IS ABANDO~ffil:tit -L $43.00 A-
ANY 180 DAYRERIOD.
cily~t(!l~ Phone_c'S?)~?4!'l Each Additional Circuit or with Service _
OWl'@i. INSTALLATION or Feeder Permit ...!:L $ 3,00 ..ifL
200 amps or less
20 I amps to 400 amps
Over 40 I to 600 amps
Over 600 amps or 1000 volts see
liB" above
$50.00
$69.00
$100.00
Signature of Supervising Electrician
The installation is being made on
properly I own which is not intended
for sale, lease or rent.
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
SignJOutIine Lightin"
Limited Energy/Res
Limited Energy/collllll
$50.00
$50.00
$25.00
$45.00
Owners Signature:
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
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- ,,1)'..,..:.... .-.........."
/fr.O;LJ
<IF gO. S1! C!.k-
-JI.. g$€5 @)
TOTAL
.. (0. 50
--.'-::0... ~
.
EL.lRICAL PERMIT APPLICATION
City Job Number ()9... - ~ifbl -0 (
r' ,IJ ' ,
'1-'"
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225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
3, COMPLETE FEE SCHEDULE BELOW
I. LOCATION OF INSJALLA TION
2-l4,n M tA .r.Vl ~.
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
LEGAL DESCRIPTION _\
17, tJ3. "\ (" . 42.. O.:l.lltTO
Items Cost Swn
JOB DESCRIPTION r~' FI'f - , 1000 sq.ft. or less .
.-t\e@y1CMWovk.:\1l1r,r, r 'ON:OregEacn'aildilional~500u to
..~,v ru es adopterl.h"'t"~ n .
Notificat' Sq"n ""'r'J..J.".m Utility
Permits are non-transferable and expiren OAR ~~; Center. li\l~fules are set forth
if work is not started within 180 days ~090 '1\ -oOl-001~~~~niitl\fH.om..e.SD1_
of issuance or if work is suspended for ir ou may obtaiNI6dUliIf!O.\f~IIWglJ/es by
180 days. ca '"g the center. ~k:e:bp.If~~one
number for th~ Oregon Utility Notification
2. CONTRACTOR INSTALLA TION ONLY CenB'! Sei-viceS'&.:Eemlt).
. fl -'S 1"J 17/J-,_'/, , (\ II\f'l Installa~ion, Alterations or
Electrical ContractoU t::;l:c01 nv,J>1 ..... . Relocallon:
I,
$106.00
$ 19.00
$ 50.00
Address ,/
City ~Ph~"1 /'
Supervisor License ~ ~./
Expiration D I
200 alllps or less
201 amps to 400 amps
40 I amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375,00
$ 50.00
NOTlG[:
THIS PERMIT SHALL EXPIRE IF ~6 ~Q~K less
AUTHORIZED UNDER THIS PERM'Olls.JIlD% 400 amps
. nature ofSupervising~rJft!m::ED OR IS ABANDONE~ft{!lftol to 600 amps
, 80 DAY PERIOD Over 600 amps or 1000 volts see
ANY 1 . "B" above
C. Temporary Services or Feeders
Installation, Alteration or Relocation
$50.00
$69.00
$100.00
Owners Nam('\feVen ~
Address ~,O .\VI-}-l 210 12-f)
Citv F~et1V Phone9)I-::#'bl
owNER INSTALLATION
D. Branch Circuits
',' ,I
New, Alteration or Extension Per Panel ,/ "
One Circuit --L $43.00 1J..!D
.
Each Additional Circuit or with Servicn 'l~ {)D
or Feeder Permit -:::L. $ 3.00 cZ:.L
The installation is being made on
property I own which is not intended
for sale, lease or rent.
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
SignJOutline Lighting_
Limited Energy/Res
Limited Energy/Comm
~
TOTAL
$50.00
$50.00
$25.00 __ _
_$45.00 , -, i
<t '1~'-7'7:-"'-'
~ ,"Ii' ._,_..___._'
.~ " I
t:="t06 ,
4lt<h-SD
Owners Signature:
Gm: ~mHS\J::)
: 39N\JH:J
OS"OB $ G:O:J3lJ lW\J
GOOG BO lJd\J: 31\JO
~S'S'BOOO-10:#SN\JlJl
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
.
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