HomeMy WebLinkAboutPermit Electrical 2003-10-23
~
225 FIFfH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAlX. t1llWj~ as submitted h~S the following
zoning and does not reqUIre specIfic land use
ELECTRICAL PERMIT APPLICATION , I ~ appro~al. /I L-
City Job Number(on,< ZOo '5 -00766 Date 10/2-2-, 03> Zoning V
1. 'iJ1!OCAf'iiiN"'OKiNST).Yl"4.TiON>;~~;1;~;~ 3. icm,'ffi]lEfErF~1:'?SbiEDULE'BEitg-W'~~:;\~a9;';lfr:~
~~\i~~'~~";'..t"", ~j,;.:.2.~:~~ilfJ,i"'''''''' -:t'~.. ~.~ ~~I)(}'~'iD\;itnr~~""'~A~fh6tt:lBd-Signatuj:&'j:'-, 1<' ~._':'" ..~~ ,1'...,. ",", ~~f..d
3 $0 J 0 L'r (nfl C 51',
LEGAL DESCRIPTION
I 70 Z. 3O'(::S
JOB DESCRIPTION"
00/00
A't-.'t\ 7
c-( e.c "",-.k
PermitS are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
lJCON'i:RAeTO'R"'INSTAi::IMUChWONEY:]
2. ~~r>,,:'t,'_-< ",~"""""'n"<l"''''I'1D&tn;l').'''~,: -<in'V
Electrical Contractor € ~<;TSJ f) C
€(,f C7!..JC
Address
3'l).).S"3
f30SCA. G€ LIv,
City
sp~{,.o
)y/-/yqCf
Phone
Supervisor License Number
lJ 717 S
lo-O/-oY
Constr. Contr. Number J J 7 7 7 0
Expiration Date
Expiration Date
(D-o/-olf
Signature of Supervising Electrician
~J.1
~
I
Owners Name Src.l'l'L
Address ?=
)/ LoLe
s/.( r;(
(J? 0.<
City #rlllit...", V'( tie
Phone
"
-.~.
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
A. ~~~~Jif~t~~1~~J~~~~~it1ti~~ili~fj~~:~m1fg,W'b~iti~J'
,~~,....o;,':,,,,,,,,,,-'~~........~~;e....>::::7",,<==~~~';.t'.''::~~n..';.-'''~
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'
$ 19.00
$50.00
t:,.": .$:-r;--fr-i-.- /V':;.... -~'.\~~_,.,..,.':." ,~J"'.~' -'~]:Io....z-,;;--:'~,.! ;'>;:. ~. .,.v.....~' ',"'.:.. >- " _.J I
B. f:~~?1~.r~I~~$.f~s il:!n~J;t~1.~,~~Pf~~i~AJJ~X~J~9j~.s 1;q,~'!}..~~!{~~,!I,q,~ ,b~~ll
200 Amps or less $ 63.00
20 I Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 Amps/Volts $375.00
Reconnect Only ~ \l',n\\'f- $ 50.00
".,." r.'_:'<;~01.",;,.\';\li.\:~,~,,-\.~~~.., .-~ <...\. J' . ..... 'bd
\~O'\~~~~~~R\~~~r~'(j\\l~' "!k ",\i.<~~,t.Z::"~
,\\\'2> \\dP,~talThli\l~~~(jn or Relocation
~\i\~\~R.O~\l~ ~'c.'A~&)'i), $ 50.00
GO ~~ to 400 Amps $ 69.00
~W~ 40 I Amps to 600 Amps $100.00
OV~E..600 AE!P~ or 1000. Volts see "B" above~_
~:~'(~ ",~~."..( .'"'-:"'. , }, ,,' . f'" 0.,.. .'. " '" ~ I
D tl.B liC ts. f o.U.\v'.r-.. :\~~ \ ,;.;u~:
, \!i;,PWc" ;-_~r,~~L . ,. ;&itl'<es:d.l:",' I;;' '1l~, '\"'~.."'"
New AIterI!N~of\~ji'fenJieJ'illg:J1>ailli\o{\
~\I\91ldl5it~u'itO?\acl b'l \n fVlaS afa s~' 00 $ 43.00
~~<tli~d1fi\;onal Clii'CiI'ilEl,r l".i1lDP;~ 'd f '-
loll~ se itelOr"F'~de teM1?V\l1l \hl! fvleS $ 3.00 ""3
'\o\i\lC..w:.n.no~.\l"'\' .c9"pias 01 \'lOne
~\l\'Q~. ., (ID\cl.ii'i_{ ",,,,''1.I\''> \e\.ll;~;."'T,e1'l'-i')"';-4~;'~"1""1;.""J';l
" ~6!'W8~f~.@~~~,;,c.~.!\.'i"I.~~~U\e"~\i19'ufd):"Ei1Ch-!.~lIa.!l9!f1
o lIin9 \\'I.a Ofa90n "2_2344).
cP1!:t%~~l!JTlgail9n ~ .BOO-'3..> $ 50.00
n\5~g1lIOl{tlin~\flIgh'ting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
'-(3)
~~'!!":""''';:;_''_''''-I'+.....'!:_,<...!i~i;; ~.!_:;';.;."'1}":)1.,~"-\f\ ',J' ,,,~!:';
4.' ?/iSb73TOTAC OE!ABOVE,;,' 'Ii'.'?,"", 4' ,:: -<:....'
1~~ -"...)","""~.,:;.. .V..;~~~ ~ ~'-' "~~:;'~ ~.' .),;~ .:i:> ....::.i~,:i-D.', .}.~
L1&,
.3'ZZ
'-(60
5'58Z..
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:YBuilding FonnsJEleclrical Permit Applic:!.tion l-Q3.doc