HomeMy WebLinkAboutPermit Electrical 2003-7-15
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAW654 1)726-3689
ELECTRICAL PERMIT APPLICATION rlCf'
City Job Number (VIl7!)l1'Y3-00{IIJs' Date 7- , ( - [) Af1lJ.~ PER:'
- ~ '%OR!2'Y11~ ~!f4J_'_
3. COMPLETE'CF."'ff:Cl1E[)f1ftiJ,'j'JJfRt32'
, JlNy 780 NeED DR OER T/iIS R[ IF T/iF
OJlv IS An PERAA' ~- WO/)"
A. New Residential- SinglePofm&b'-I'M\!YcWf'/Il\:l'PS1}t(i1I1ft.
Service Included . ED FOR Or
1000 sq_ ft or less $106.00
Each additional 500 sq. ft or
portion thereof "i /
fOI It:.
Each Manufact'd HO~' PfOlj, I~IIV
Modular Dwelling'lS (~or .rv/(il I~. t: $50 00
F d n 'L1 "'t~o ;s' "r", .
ee er vO$! "ff:( B r, C. ''''0 .$f".,
~ y.:S-,? 19".... rclteq '. -.:.,. . _
B. Services or E);~-<in~I<<ii.i!'b'bj\~~s (4'~~locati()n:
VI})66 'Otlle ~06 'Ot, 06'6,., eO,., 11'6.sJ.l
200 Amps or less ,. fOr, "19", I'qil> ~l'o~~egOI> t/.Ottfo
C' I~ .t!)1' ~o.. rI> fl,., ~ .
20 I Amps to 400 AmP~f)'e, E> 0,., . (1\0 10/051 . 7~ e '%>, ~'
401 Amps to 600 Amps IS"8~OI:)~e.'"" W?,f9S:" _~
601 Amps to 1000 Amps n.;>,,-l'l6;';~~I~ VO,.
OV\6\\1l0ffiIl AmpsNolts . '--'?'~J~. '"' 0)1
6""s!\~~actOnlYV50. ~
~lnlc~, ~su'O~~\:'Qec\\\C
Supervisor License Number {dr7< ~ ):;o\~\~ ~e<\\}\ n _ C. orar' ervices or Feeders
- ~\o-:-l\',\1 dOeS" .\ ~
~"o \0 ..,,6 0
n,(\Q' ~\ '
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I. LOCATION OF INSTALLATION
9 01 tV Q4/:&/f/?/e.
LEGAL DESCRIPTION (,/
/7()327~1 fJ2/0/
JOB DESCRIPTION A2
'T~~ //~?YL
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Snspended for 180 days.
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor
LUJJr1J's f (~C-J-
,
Address
City ti-d'!./Yl 0
Phone
Expiration Date
Constr. Contr. Number
Expiration Date
Signature ofSupervi~ing Electrician
The installation is being made on property lawn which
is not intended for sale, lease or rent.
Owners Signature:
I~
(
~:&--p
f/-:'l'
h7
Inspection Request: 726-3769
"
$ 19.00
Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
,)DM
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 Penll.it
$ 43.00
$ 3.00
E. Miscellaneous (Service/feed... not included) -Each [nstallation
Pump or irrigation
Sign/Ontline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
,) }). tJ-"
(,To
_~6-'
.<)?5 .)0
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drivc(T:)/Building Fonns/Elcctrical Pcnnit Application I~03.d(lc