HomeMy WebLinkAboutPermit Electrical 2003-10-20
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number C/Itt( 2CEJ ~ -[) /t'JtP (Date
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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\('~ Service Included
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0'~ .:,~0 1000 sq. ft. or less
_~~'S'\'ll' Eph additionalSOO sq. ft. or
portion thereof
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
"'CONTRAGTOR'INSTAl1l'itTloNioNf,yJ
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Electrical Contractor
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Address
City
Constr. Contr. Number
Expiration Date
Signature of Supervising Eleetrieian
Owners Name 65 L CXv k.~ '-'\
Address '"P. 0 I .~~ 7.04 \
Cityl1ruct-II,'<; Phone72~-o~~O
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
O~ture:
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Inspectio~ueSI: 726-3769
$106.00
$ 19,00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$SO.OO
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B. - ,:Ser,vi1~:,<ir$e~de;~t.~IIistall~i~n;~A.iieta tio~s~ot::Rt{lota ti6n: ,i~' ~1
~'\;;:A.,.-"..0"t<,-",',&.l:<:.,...>ti.,~,j"jlti:N.-*.1A~i.i1J"',~"';'f.-.,~(:""''''~~'.~~J;~
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 7S.00
$125.00
$163,00
$37S.00
$ 50.00
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. L..a~pP,~r:.~.ry~ ~~~.:!.~ts ~rc ~~~I~~\.".,6li,y-:;,'O~L'~~;u~~ ~ ~-".i'~
Installation, Alteration or Relocation
200 Amps or less "- $ 50.00 ~/'r~
201 Amps to 400 Amps $ 69.00
401 ~r'I'L:qqq-ronll~regon law reqUlrI$:r<ltA\b~o
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. . .antDi",,,,,, ........ .i....'>""~ ",;+"",,",",,^:, ,At.\,..""-,,,,~'1"
.. :.Q....'F\9'5.:~;;~,OO1'G: f-ollQ,Al;#m ."'-".lO'..,c_,
New,\\\'9Q~tI?8tf\if.ijeeti\'8iJ\C!:<J\~itet of the rules l
One ci:1~~\Ing the center. (Note: the t~ru-o~e
Eaeh Ad~rti!W~18i\f~i\&f(}\4\1Jon Utility Notification
Serv,eelll~'F'e~aer.t~~fie 1W:)r. ~?2 ~~1~)?:00
~~:~''''~'."~~~.,, .-4:Z~":"r:~:-:~;~, ,-,'" ';,lv.:"7::,~:::'~>7;~~s:2!~">".;, :'1"-w-c:~'i
E. ('.1'1J~~~II.ai'~!'l's J~er'vic~if~i~~~.t lJiCl~~ea),~.E'~!1 Jrij.tauitiort~
Pump or i~9.l~~~M\T SH"LL FXPIRE \1$1b1.60WO~~
Sign/OUtlJ;~~irE~~l'zED UNDEfl1HlS PEIiMo1>bS I~\J
Limited E~V. WE\~t.'1!i310R IS AB"NDOl,~J61R
Limited Enl~ \'lro"lJwiaPERIOD. $ 45.00
Minimum Electric Permit Inspeetion Fee is $45.00 + Surcharges
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7% State Surcharge '] r~
10% Administrative Fee r ~ L/
C- q., J()
TOTAL
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Shared Drive(T:)IBuilding Forms/Electrical Permit Application I.03.doc