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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 1. r;;;OCATIiiN7/R..INSTA i'i4.l'WN;",'~.'Pq[~~ ~:IiIIia:~;i<.<..o.~"~" -,.,..;...~~- _ 'L. "~~ '_':ff,~~~~ '] '33 q I ;;; Ie tJrt if. LEGAL DESCRIPTION ! 11; z.. / 7' 3 {- ()c;cjr.h; JOB DESCRIPTION Tt'Yz4?/Y ~c:uJlH \('~ Service Included ~o~ 0'~ .:,~0 1000 sq. ft. or less _~~'S'\'ll' Eph additionalSOO sq. ft. or portion thereof - 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 2. t~::~1'i7t:t~~~~~'_f';""-"f"'J;4,"'-U:';A!;t;Dii%z,j;::',' Electrical Contractor // / ~ 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 l -~-~. .' OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. O~ture: </ IA~ ------.cJ ( / / Inspectio~ueSI: 726-3769 $106.00 $ 19,00 Each Manufact'd Home or Modular Dwelling Service or Feeder $SO.OO ~". ~.~- 9',_'_:"'~~~; -: '_'-' ,,',~"~'~':"""'f!:o:-\t-''''/'"1'(;-::-:"=~::-) B. - ,:Ser,vi1~:,<ir$e~de;~t.~IIistall~i~n;~A.iieta tio~s~ot::Rt{lota ti6n: ,i~' ~1 ~'\;;:A.,.-"..0"t<,-",',&.l:&lt;:.,...>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 C f''''T''':'rJ'.. .;>-~"..,;.?t\;.,,~S' '.; "j:."....~- ..~F'..'''"''d''~';'..I\'"'f>i~>jjS,(~:-.)i94'.;~~4'&~::'}'{~~~~~~ . 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 D O~::B~,~~,...~83I\l~;~~.-~~~,~.~~~!i;~J;~,.,. X:Ct"'&~'. . . .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 4. YsDBTOTAt'()FW1(h1Ei'''~<i1:;!.i",,:,:.'i~j ~,~ ".,""",,~~~ - ",..\'~,., " '-21,,~,""'''--~'h1~;\i-~-,,-':~~'~~,:i,l ."..-....",..., d...e '~~~....,........~., '.q'- ~~~,~.;",",_;~.;..;,;;.,.....-_' :" 1'-1,-/- 7% State Surcharge '] r~ 10% Administrative Fee r ~ L/ C- q., J() TOTAL - . Shared Drive(T:)IBuilding Forms/Electrical Permit Application I.03.doc