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HomeMy WebLinkAboutPermit Electrical 2003-11-13 ,J .J ~sS.,\", ;\ J> I'F3 0 -:r>f5 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CO~"'" 2.003 . 0 1/3 C, Date .. B.fJSeI'V bJffJf"'\~')oI'" \\\. . "iv' ('. . e.(>'''''. ' '1 ,\\1,;'. , .. .C(\ '" ",,\\U2Qb~pS9J: l~r;~ 1\\\ .\b? ,-\\\'.,. . .V'\)\' ,,,o'o'J "i\"'" ." \\'" ,\'(}" ._' '0.'- 2QJArilpstMf.0uAmps'\u O\\e .' \\1:"'.'\<:;" f\\':Y"" '^'""U ,,,,c'0". \' aNJ \, ,,",040~,ot1i1pS to-KQOAmp@\'-'\. ,)\\0 ;'j'\" '["~()~\ "- ;,,\" ....-,)....- ',-~ ,",..","< .\~~~, ,- 1,\\\(/': ',' ,,;).,.' "\\: ~.,\" ':? v ~\O,. ",..\\\c, (....;",;~:I" ',6.01;~,ps,t.:Q,\10uO.A.~p,s" ',' \',,;\. ~_ "~\ ,:,,)..., ......,?',r ~ r~ \,~ \ \\\\,~) I,.,\L).- o i~'( ',-{ 0') '~\'.?X@~'l~~~,.~ps,~olts '.., '091.). ;" (\ \',\'R~cQn,nect I.1nJy-' ' ') .",\1\\ \.~; ~()\,\ ". . ~ .~ CV '>(\e' \-.. __,<,;,,,::::) (\\\~., (C'w:por ..... ".'..'..'...J'lc~s;;t\F~ .".,"".'0.... ".~~~~ Installation, ~~\S()~\8.'\location 200 A~'Wt~\~~\\ '\ \)~ I $ 50.00 ~ ~. 2~~~~\6>~~~~ $ 69.00 " \~;~~~~~~~:~~: Volm see "B" above. $10000 ',: \) \ ". \ .' ,c,\\ \n: ,j:~~lJITIiGir. c.u, ,.,i,..,. ; .... . " '_ \'..\.-\,;.~ \\..- \) ~'~f'.-;.\-.,..:/,::::;::::.,:,;::;,::;:;:.::::;.~;;<<::::;:;:::::./:::::::::::.:::::~;;i.::<:.::: C'>J~~ \ '6\) New Alteration or Extension Per Panel \,,\~ 0 C' . r ne lrcUlt Each Additional Circuit or with Service or Feeder Permit 3- !f~94r1t!!!l~::;g~IIJJi0 p, LEGAL DESCRIPTION /7Dl '7Cf~ 07500 JOB DESCRIPTION ,G-vt f' -? 6f.,JL~ 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. Electrical Contractor Address City Expiration Date Signature of Supervising Electrician Owoe"Nmne Ge-4 Lar(L/VI Address ? (). (~Q)( ~o1- { City COV'vc< r (,') Phonec)41'-?~.,78''?/ OWNER INSTALLATION Owner/;' nature: ~ Inspection Request: 726-3769 II /J; /oJ I 3. A. Service Included 1000 sq, ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feederj,"\\.c ~. .. $106.00 $ 19.00 $50.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 5-0 $ 43.00 $ 3.00 E. Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. ~o 7% State Surcharge 10% Administrative Fee '?J"O .> )CO 58')0 TOTAL Shared DIive(T:)/Building Fonns/ElectIical Petmit Application I-03.doc