HomeMy WebLinkAboutPermit Electrical 2003-8-15
^,. _ CITY OF S JNGFIELD, OREdoN _ . - ~
I 1~1I~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-M&1las submi \edl18S e
ELECTRICAL PERMIT APPLICATION ThelolloW~~gJoas not ,aqutra ~
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City Job Number ~ 2C03. (X)5rf.J. Date t7 ~ Q3 approval. . .JS /0
1. LOCATJONOFINSTALLATJON>' 'j 3. ~OJl1P~ETEFE~~.9!f~:'~~:ELOW ,,-'- ~
1/ cc... O~. , S' na\ure-
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LEGAL DESCRIPTION A. New Residential- Single or Multi-Family per dwelling unit.
17032\'17 0/200
E. Miscellaneous (Service/feede,' not inclnded) -Each Installation
\\1U1ICE: ^ .~. PIQE IF THE WORK
:;UI<; PERM~~b~~\' tidh'PFRMIT IS NC:; $ 50.00
AUTHORIZESlg\Jlliil1figet:l~tlnl$ FOR $ 50.00
OWNER INST ALLA TION COMMENCEUoGcfu \5,[}~~Rf!~~P.l $ 25.00
The installation is being made on property I own whi&"IY 180 oe.'fnfl&PiQRgY/Commercial $ 45.00
is not intended for sale, lease or rent. Minimum Eiectric Permit Inspection Fee is $45.00 + Surcharges
JOB DESCRIPTION
~TT
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. ,CONTRAcTOR INSTAL~TION OlV~y
Electrical Contractor :)' B' aF..-ruG
Address Le~~5 T5Ir8~~
rJ!. fHo'2--
City WGf1A)f5. Phone ~?} -51- ~o
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I E> L{ 92 9
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Expiration Date
Constr. Contr. Number
Expiration Date
Signatureof(yX~
/ ~1t:7" ~\( ll<'" I
Owners Name ~ Q~
Address 21 '" 7 01, ......'7. ~
I
City
s?/-"b
Phone
Owners Signature:
Inspection Request: 726-3769
Service Inclnded
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufacf d Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B_ Services or Feeders - Installation, Alterations or Relocation:
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
-2-
l).-~ .~
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c. A;i~i!.'ROr!L11\~~~!c..~oniFeed~f~JlreS yOU. ~o
follow rules adopted by the Oregon Utility.
NJmre!Wi'!~(.>\!!~r<y~jo''"~.!'~lteiocatlol1re set fort .
'n2.99\~P}~ot\less.001 0 through OAR 952$''5'0.00
oGg!J~n1ps ttl~4QO(Kmp~n copies 01 me rul~~~.oo
4Q,I1i\:mgstiO!600ll\ifips (Note: the tolapno~I-oO.OO
()lImNv 'n. thA n'.E!!:lon1 Utility, ~Oll1lcallon
ver-MJU A:mps or lOUO-Vatts.&ee B': above.
D B Cl'!nter is .1-801 -\j'-1:.!-2;j<l"'., . '
. rancu ClrcUll~ ""'. . "
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
~[2 $ 3.00
1-U>.oD
4. SUBTOTAL OF.ABOVE
J. Lf (p .00
(1.1.- ')...-
d4.<oo
d, ~1.'t)-.
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)JBuilding Fonns/Electric.lI Pennil Application I-OJ.doc