HomeMy WebLinkAboutPermit Electrical 2006-10-4
.. ClTY OF SPRING:. ),LD, OREGON
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~ . INITIALS NH
',:( A!. .. DATE \\'l-.:.j .Um<;o
" ",'"' IiMJ' SOURCE
225 FIFTH STREET. SPRINGFIELD. OR 97477 . PH:(541)72&-3753 . FAX: (541)72&-3689
ELECTRICAL PERMIT APPUCATION
City Job Number COM 'Z.OOb - 0 rZ \ 0
Date t'D - '-l- -2 cruCp
I. 'LOCATioNOFINSTAri4TIQN:;~w~~~~\(<lt3yu,u;1 ~OMPLETEFEEscHimULiBEiow - - ---- -I
Y"J i ~ll~~~;:;~~ciregon \!l~'~rt\--- u - -- --- --- -- -- ---- - "
LEGAL DESCRIIJtl~;\':tc.'a' :~~ Center. 1 nOl>"U;9~~~:~ ::'2l~e"~Resid;~ti~l=-si~gle -.;;. M-u1ti-F~;;;' ;;r d~lli;; ~;;!t. - .
,-, 0 '2 "] ~1'~9S2~'~~~~P\0S ot th9 r~~~rtY~c~ Includ~d - - - ---. - -- ----- . ----- -- ---
~"^SO 'tou II"'Y - N te' toe telep
JOB DESCRIPTIVD/II' thO ~ntlllr. { 0 '111\'1 \'lotilicLQOOOq. ft. or less $106.00
~\IIi'ltJ jrSJ/.'n1ll 010{!On Ut 344). Each additional 500 sq. ft. or
-r ~ f' ~\l~:=>::~,c 1_800-332-2 ponion thereof $ 19.00
""". .
Permits are non-transferable and expire if work Is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder .
$50.00
r -~-_.. -- -----.---~-._-_._._---
2 CONTRACTOR INSTALLATION ONLY
. L.._ . _ .___ _.. ___.__ _ ----.---. - - - ~
,------------. ---. -.. ._-_._-~-
B. , Sen"ices or Feeders - Installation, Alterations or Relocation:
City
/
Phone /
/
Supervisor License Number /
/
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Electrical Contractor
Address
r - - - - --- -------
C. ~~po~~ry Ser_v~ces ~,:!eeder~_ ..__
Expiration Date
/
Constr. Contr. Number
/
Expiration Date/
Signature of /uperviSing Electrician
I\1U 1I1.t:
THIS PERMIT SHALre!(!l'l'Ij\ill!tlf\li~tWQ)~elocation
AUTHORIZED UND~Qor.fW!Pfi!rR<MiT IS NOT /
~0MM~W'ED OR Ig~lffiWlHJi\4\~!H't9If
ANY 180 DAY PERI611i. Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. I-B;~;;ch C~r:.c~it~---=_- -- ---
$ 50.00
$ 69.00
$100.00
~D
--:
Owners Name b~ LAa.t.c:""
Address -r.... ;:z...x 87 "Z.
City~n-+L..~ Phone
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E. I Miscellaneous (Service/feeder not included) -Each Installation i
OWNER INSTALLATION
The installation is being made on property I own which
;;:q.snot in e~;fled.f<Ue, leas or rent.
e 51 re: -
. ' .
......,
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges
4.1 SUBTOTAL OF ABOVE I ~O
.,
~
8% State Surcharge
10% Administrative Fee
5% Technology Fee
2 ,....
Inspection Request: 726-3769
TOTAL
Shared Drive(T: }'Building FonnslElectrical Permit Application g-06.doc
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