HomeMy WebLinkAboutPermit Electrical 2006-1-3
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ClTY OF SPRJNGFJELD,IOREGON \.-'
SPRINGFIELD.
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225 FIFTH STREET 0 SPRINGFIELD, OR 97477 0 PH:(541)726-3753 0 FAX: ~~~-3689 , ~"
ELECTRICAL PERMIT APPLICATION ~p~":~g, ~~~n~prO"CI .~ ~ "
City Job Number C.OHA ~OO S - 0 /1.{ cr 0 Date val. / - ~'>rJ~il',_
Del <OfUf) re sp ~as II)
3. COMPLETE FJI,E ~ u'E eClfie la~;O/JOI>in
Ul/'onl re... uSe 9
eo s.
Ign~lur
A. New Residential- Single or Mufr
1.
LOCATION OF INSTALLATION
N~(...,.
10 z.. z..
All
LEGAL DESCRIPTION
170 "3 Z 7 2 Z.
OS 700
Service Included
JOB DESCRIPTION 1000 sq. ft. or less
J. , I? _ L Each additional 500 sq. ft. or
1'CJd... .> C-l rc::......., (] \. portion thereof
,ATTENTION' O'er..qn law requires you to
Permits are non-transferable and expire if work'!S . Sicli i~;rufact'dHome or Utilit
nol started within 180 days of issuance or ifwoJkl\pW rule~ 'Mfld1{~?DWeii1fjg\Srr'~mJ1or Yh
Suspended for 180 days. Notification C(Fel;ifer Those rules are set fori
in OAR 952-001-0010 through. OAR 952-001-
2. CONTRACTOR INSTALLATION O~{;-fo. You n~..:y ~~r~!~~!;ep[esd..e:rY,;?lnstalla'ti9n, Alterations or Relocation:
/calling the center. (Note: the teiephone
Electrical Contractor r::;:;,ber for \fRJlOi1J~.:Rr !5~1,iIY Nntlficat;on $ 63.00
/ Cent~P10r'B~!.0,1gQ.~'!JPSI). $ 75.00
Address 401 Amps to 600 Amps $125,00
// 601 Amps to 1000 Amps $163.00
P.hone Over 1000 AmpsNol1s $375.00
/ Reconnect Only $ 50.00
/
Supervisor License Nu~ber
Expiration Date /
$ 19.00
$50.00
City
C. Temporary Services or Feeders
/
,
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
$ 50,00
$ 69.00
$100.00
Expiratio
Signatu e of Supervising Electrician
New Alteration or Extension Per Panel
One Circuit $ 43.00
Each Additional Circuit or with I
(' ,."il ~ "l1 ~ ,rJ'\r--,c" Service or Feeder Permit $ 3.00 . b
Owners Name Jlrl~ V'\( .\Y , I\), )
Address I 017- ~\ r \ A n\!f> E. Miscella'lJ'ous (Servicelfe~der not incll\<l~nWb Installalion
. - . .' \ ' ~O'tM~~~ 'E)UlIRE \1( Wit lJ1lur\l~
City ~\(h.P.P\d...9'ih-6ne.sA\-4\6- ----v1o=r pu_iQ~l SHti~ lH\~ 9ER~IH~~9t
\j Sig'}i.~~I},~t.\ ASAW)Oillf,D i96.00
OWNER INSTALLATION Lim~\lAMIi~A&~~~D. $ 25.00
The installation is being made on property I own which Limi~1Int6@teh\'liJmr $ 45,00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
l{J
8% State Surcharge
10% Administrative Fee
l{7
-:s 'z
v ,"0
~ 7 8Z.
Owners Signature:
r j)~ V-o>N~
4. SUBTOTAL OF ABOVE
Inspection Request: 726-3769
TOTAL
Shared Drive(T:YBuilding FonnslElcctrical Permit Application 1..Q6.doc