HomeMy WebLinkAboutPermit Electrical 2005-1-21
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, :. CITY OF ~_"tlNGFIELD, OREGON ,,0<'
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F1t: (54~89~o'
ELECTRICAL PERMIT~PLICATION '1 "'I" ~ 0"":"",,,,
CJ - 7 VI,j ~~. -'0 IS'
City Job Number 'I)IlIA7J -/) 1c;Jf5 Date o~, ~ 'I" "v6 ,
-- . ~O' " 9"...~ ~~
I. r'WCATION6FINSTALLAT~ON' ,1('. i 3. I COMPLEtEF.iK~i:X.l: aO~~~~'-__'
//53 /'0tJ11AClO fJ;r W' . ~,__"_ __ _" -,;;"''';;~~" __.
LEGAL DESCRIPTION A. L~".~ Resident!"!. -:Single or J\___ti~_. i",)-dwetling;\I~~ .
/ 7 () 3 ?, S ./_ '( o? f6trD Service Included ;S
2. ! CONTRACTOR INstALLATIONONJ.-y..1
Electrical Contractor ~4 ~(
(O.--z Q ",rnJ <" 20 I Amps to 400 Amps
Address i I 0 {) 0) I ~, ~ T . 40 I Amps to 600 Amryou to
~f)() ..( '7'7,Q,('N: C60"11~\hb1~f?~R;~Utility
City ~I ~ 0 6~Phone 7 '1-7 -~I", ad'0\1frqlillbtA~~SVci\~set forth
r\'on CenR1J"cohHPc'i'O'n,i'\ OAR 952-001-
, 001 0010 throug ..I, b"
Supervisor License Number 24 3>~.5 i~~~I~r"v~~2:n:<s. tt!f~i>~i~=~ers '
( ,....,A07 ( 0;;;;\110, ,he "",wet ,^."'i\'" Noo- ,
Expiration Date I C)- ~ ~ber lor t\1JnR.\~W~!~ or Relocation
, - cent8Jd81mps or less
Constr. Contr. Number _ I 'L 1'1 2.. 20 I Amps to 400 Amps
S ~ 401 Amps to 600 Amps
Expiration Date -l.~ -0 _
Over 600 Amps or 1000 Volts see "8" above.
Sig ature of Supcrvising ElectriciC' - D. 'BtanchClrcuIts: " " '
J08 DESCRIPTION
~/3:lM<jeq ,~~ ,Iftu/BJ
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1000 sq. fl, or less
Each additional 500 sq. fl. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
"-
$ 19,00
$50.00
B.l!ie;'vi~es~r Feeders - Instal~~ti(j~.'.. Alterations ~r Relocat~n~
200 Amps or less
$ 63.00
$ 75.00
$125,00
$163,00
$375.00
......-- $ 50.00
L:;77. Ci'~'?
,
$ 50.00
$ 69.00
$100.00
'\"
'j
,,' ~
New Alteration or Extension Per Panel
One Circuit $ 43.00
f\ Each Additional Circuit or with D 170
wners Name l-~ Uf&~L . Service or Feeder permit, \'l'JOI( 7. " $.3.002.-7,
Address JZ~O \,(~ 'k J'7M") ~\~~R~rl~~~t1~lfe'o1J?~~~~~~f{UiPt iricluded) -Each Installation. I
-e, - - - - \ \1\~ I \NDER 1\1\;) - rOR
City ~,,; '171f,)/ Phone .3...4-'7- 4- 7.6/rHORllfP'1riip. or\~ll~!WiDONED $ 50.00
COMMENCSigJ&'tlill'(jLighting $ 50.00
OWNER INST ALLA nON p,N'{ 180 Q!;-i(,i~~~~er~y/Residenlial $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
The installation is being made on property I own which
is not intended for sale. lease or rent.
Owners Signature:
Inspection Rcquesl: 726-3769
4.1:~Vldq~AL;9.,f.~~~ ;;(
,~ . .
~'700
, 5.3'7
7, 7tJ
90:07
1, ,'.-,.~,'
..' "
7% Slate Surcharge
lO% Administrative Fee
TOTAL
Shared Drive(T:}lBuilding FonnsJElecuical Permit Application l-03.doc