HomeMy WebLinkAboutPermit Electrical 2003-4-21
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d". . ': ,'CITYOFsL.rnGFIELD;OREGON (') ,'J
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b 'tled hes the following
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FA:X;~jj~l)\l'llm~~ssUUi: specific land use
loning and does no req
ELECTRICAL ~ERMIT fPPLICATION . / / appro~al. (I.l
City Job Number (0""'200;> - 6003b Date Iff I !Sf 0 J Zoning ~
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3. COMPLETE FEESCHEDULE BELOW <::Kt0
A....monzed Signature
I.
LOCATION OF INSTALLA110N
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LEGAL DESCRIPTION
170's Z 74 (
JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
06700
2.
CONTRACTOR INSTALLATION ONLY
A. New Residential- Single or Multi-Family per dwelling unil.
Service Included
1000 sq. ft. or less
Each additional 500 sq. fl. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
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$106.00
$ 19.00
$50.00
B. Services or Feeders -Installation, Alterations or Relocation:
Electrical Contractor ~"Vit:iIJ et.<<.Jtflt.,~,IC,
Address ~y '11.~U
City --.S!'.[.J Phone V7 .,e9 z.
Supervisor License Number ;2/ 9 if .s
Expiration Dale J ~ - 0 I - Z. (J d L
Conslr. Contr. Number L I, 5/ <i
Expiration Date ~. Z I . .if II) IJ "
Signature of Supervising Electrician
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Owners Name H-o '^) ~c;.
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Address
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Phone
City
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
200 Amps or less
20 I Amps to 400 Amps
401 Amps 10 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
. $375.00
$ 50.00
C. Ten!p.orill~ ,Services or Feeders E WORK
~~~\\I'C' l' S\-\f\LL EXP\~E IF 1\-\ 01
Inst:i'JhitIo~Ulm~t'0D~ort\\e\i\'i\l!iQlERMI1 IS N
200 A'\b\1~9~~~E.D ~~ IS f\Bf\NDONED ~~.OO
201 AD\PtI~~Wj~~~ER\OD. $ 69.00
401 AJh~IJ~bb~ps $100.00
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
e,qunes'10U.t?
E. Miseell.neYr6{&~~~li~lII~oljV&~~tiBl.'I'h Installation
AiTEN dopted by the re se\ IOrt,1
Pu~ro'1\CjWi~)llt6~oter. IhoSe rules ~ ~9!l,(llj)~
Si~~i&t\9tgl'OO~ 0 throUgll e; 'J'I~ A,O.oo bJ
L. ". f':\A Q~ "d, """in COP"':>"'" ,(>"",,",,,,,
ImllOO'B1e sa.,el!4J'U \~ 0 t"I"",,"D.u~'
nna!\ U '\'lotl:!.' ",,, "'~O\,
Limlrellal\rJl~~ererat~ \ on UW,\l>j NO"\4\)!UU
Minimum E\~fJliitllle~li\i~fn'\f?h~~cf.~IH'4S?o"h Surcharges
center IS
4. SUBTOTAL OF ABOVE /Db
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$ 43.00
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drivc(T:)/Building Fonns/Eh:ctrical Pcnnit Application 1-03.doc