HomeMy WebLinkAboutPermit Electrical 2003-7-1
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (?~'tr12~~61I9ct as submitted has the followin
ELECTRICAL PERMIT APPLICATION '~~a~na doas not require specilic land use 9
City Job Number (.Cw1 ZOD] - 00 l-{ l, I Date _ Lt:;)- - .;:;)5'" 0 ~ 'Zoning (I Q.."
1. LOCA110N OF INSTALLATION 3, COMPLETE FEE SCH"VlJLn .onL"": rJ-I-a,.?
I '.LbU SIb/nature CJflJ
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LEGAL DES8{IPTioN A. New Residential - Single or Multi-Family per dwelling unit.
170"525''-1 Z- 01100 Service Included
1000 sq, ft. or less
Each additional 500 sq. ft. or'
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
JOB DESCRIPTION
A-~ ~
C. \ a.c...v...\ +.::.
$ 19,00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
$50.00
CONTRACTOR INSTALLATION ONLY
B. Services or Feeders - Installation, Alterations or Relocntion:
2.
~Iec. trt<.. -roc.
$ 63,00
$ 75,00
$125,00
$163,00
$375,00
$ 50,00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts ~~~~
Reconnect Only '\'(\~ c ~\)'
R-'i:.. ~ ~"\ '\... R-
Supervisor License Number ..3lDaLl - S C, Tempora~\..-t~~ ~~tll3~~
f,.' S'(\~-l:-~ ,'(' ~~~
Expiration Date \ D - 0 \ - O"-{ \),\\~MWJ1lliolJ~'t.~aflO~or Relocation
~ '(\\sW"O~~ G'~ ~~~. $ 50,00
Constr, Contr. Number (<> I 3 L, ~ '\ ~W~$s\i~'Q&.~IllPS $ 69.00
0,. - \ a -0 S"' \~Q~ \.gn~'g'600AmPS $100,00
Expiration Date w -\ ~
\,<",r 600 Amps or I 000 Volts see "B" above.
Signature of Supervising Elec rician D. Branch Circuits
4,../7. ',./. ,1/,/ ,n, New Alteration or Extension Per Panel
:Jo/ 4f-jv; ~ One Circuit ,,'''' \ $43,00 43.00
(J Each Additional C(~uiffr,@h 1i
f. ~ L Service or Feede~Perri'iit ~,,"', $ 3,00 I~. on
Owners Nallle " i2.~ --:J/./IL "V-ll'~,O\:;'.J,(:' _".,.\)~,
Address .:2(') ? <, (!) / L\.... 1 (' . . \'-t_ E0\J\fi}s.e,lIa~~;:;,us (~\rvic~r~~der.~lOt included) -Each InsthIlation
~ ,. j' } ...J ,79- ..)0'.\U'?""'~(" ,,<"\" ,'.'::-' ~,,(ji', ~
City 't-IVlr rre,J, Phone ,." .L'~pulllporirrigation,,-,r',.r\rf0'r'^\'O $50.00
. --- , ~...-;.o ,\\.' ",l'~ ...-." . c'\~ ,', ,-
J or. " \~ "CSig(ll.o'11,t1!~,~Lig~ti!ili': ,~\r~" $ 50,00
,,\\'0 \'~) _,\', _\...... t..\' -,'-- ..\..'. ,\",.
OWNER INSTALLATION \U ,v'.. ;;"Eimited Energy/Residential~" $ 25,00
\.\\ ,'- "'J ~'-.\' 6" "'."
The installation is being made on property I own w)~1~!lJ~:~\~~'~'\~~~,ited--;";:n~.rg~R.~m~ercial $ 45.00
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IS not mten e lor sa e, ease or rent. \}J~l I\1,~nimu?,~Ele';tric"Permit Inspection Fee is $45.00 + Surcharges
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{\\,i~ SUBTOTAL OF ABOVE
Electrical Contractor
\1.\~ ~ ~L.l ~. \oJ
Address ~"
Phone ...!:'l$ - (0 11.L
City
~Ilq~
~S:. 6~
30.~5
~.~O
~
Owners Signature:
7% State Surcharge
10% Administrative Fee
TOTAL
Inspection Request: 726-3769
Shared Drivl,..'(T:)IBuilding FonnslElectrical Pcnnit Application 1-03.doc