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HomeMy WebLinkAboutPermit Electrical 2005-3-4 225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX; (541)726-368~~\\\: ELECTRICAL PERMIT APPLICATION .- c\'C,s "':o-0\~e ___ of' \ ~ City Job Number / '> _ (J()I'-f~ Date . ~.y\ s (,\0 , 0""'\ 0013 xc:. ,<,<c'c.....<.... "n\':~\ 'o1>c{),o '.. fo". 3. pplllPLETKFfjE ~CH .....,.".... ;.... '.' . ','-l;:,:~~o"'tef'i fOo\"Z- OrJ"j LVI. LEGA~ESRRIPTION J ~d~V' Ma~uJ'i... ,2W A. ~(J \ 1-\ S5111n~ fA-~ Sub i..of 110 Service Included JOB DESCRIPTION . ~ # \ (lID' /) 1000 sq. ft. or less J\\.1/ ~tYI nEach additionalSOO sq. ft. or ~J "'"5~ fa ~r fe ,d (~.f U + \V' \ portion thereof Permits are non-transferable and expire if work is Each Manufact'd Home or not started within 180 days of issuance or if work ;'S Modular Dwelling Service or Suspended for 180 days. Feeder 1. 2. Electrical Contractor -;7-Io.RtJ J7{J jJ\. j 8k.l KJ:::.. Address I? () ~&ir' SVLI <) City ae.c:r-- u Phone f)~ -W~( .2,., /7 (7 Supervisor License Number -.JC/ ~ Expiration Date ICl/ /- 0 (0 Constr. Contr. Number I / It? ,~~ / Expiration Date /(I}-/_ D b Signature of Supervising Electrician ~JL-2_S/~ -:l Owners ~e Address vf\ ~ . _ .. Ci~ ~~ Phooe -W}(Y \CS \ 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 ( ~ $106.00 100 t00 $ 19.00 :>l:5tOC) $SO.OO B. 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsN olts Reconnect Only $ 63.00 $ 7S.00 $12S.00 $163.00 $37S.00 $ SO.OO c. Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps . Over 600 D. $ SO.OO $ 69.00 $100.00 ~(oo New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 E. Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ SO.OO $ SO.OO $ 2S.00 $ 4S.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. I q~,oo I ~,S-6 ,q,,-/O I J-~,1G 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonns/Electrical Pennit Application l-03.doc