HomeMy WebLinkAboutPermit Electrical 2006-5-26
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ~ ZOO 6 - 00 b'-{ 3
Each Manufact'd Ho~~&r
Modular g;-v,~l!i~-g\S~fY\~~ or
Feedet I \,' .,' J ,I ' "", _"'(\
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2. CONTRACTOR INSTALLATION:()NL't~ ." "" _,~:\.-~'~~v.~~~; ~~.~~.~~:_~~~~t~i(illation, Alterations or Relocation:
Electrical Contractor ;tles'lt-;qL :SI~~ a.~ .v\ f,:>f~ ;;;1' -~io6?~~eS~'6r=1~s :'\_:,~})\\o~e
,_ _. . ~-y- \. r>\\\ I ,.L.,,,:\ i~..._.,1". "(\0'(\
. '.:' ~ ". \1 caorAmp~',tO 400 Ampsca.
/ c; _' '(l: \1' -.. '\. ~'J-'; '\ ~~. J ~ "'0.~. \- \""\\,'\\~ ',~I...J,
Address v Z-f) s:: ".S1"u 7 i.- "~ '" . J ,.' .' \'0 ~-:';40.IAm.l?S\ te ~9Q)A,J.,nIJs
I /.:;- '" c."..r;'iU\'(\-\~oY~p~i8i'6oo.:J Amps
'--1'-:' 'rf) ~o-3 J .r",I,J~ - \.?1 I';;
City I I (rMLL\. ,(AI'-' Phone ('-7r'-B'-}';~I~ C8\\-uverlOOOAmpsNolts
C;-l 27.' 'f 'Q '-1-./ .,- --- Reconnect Only
1. LOCATION OF INSTALLATION
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LEGALDESCRIPT(ON J703Z.$'1.( OIDDt
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JOB DESCt!'PTION
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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.
Supervisor License Number
'SItE- C:b C-:-
Expiration Date
i C' --0 I --(:) t-
Constr. Contr. Number ~/7 I.{ ("J / V
Expiration Date /--:?o -l) 7
Sign~ l Sr"Vising Electriei'"'
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Owners Na e I KF t!- / L J"S-
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7,~'7" (')L"-f.nnti". 97-.
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City ,;ill- lIV7 <I f uM Phone (~-f:.J '.......,., ') ,-
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OWNER INSTALLATION
Address
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
ZON
INITIALS
DATE
SOURCE
Date
/.- ....,/ --1' /
,,') -~C1 -c.' ~
3. CO~lPLETE FEE SCHEDULE BELO~V
A. New Residential- Single or Multi-Family per dwelling unit.
Service IncIu'ded
1000 sq. ft. or less ,
Each additional 500 sq. ft. or
portion thereof
$106,00
$ 19.00
$50.00
$ 63.00
$ 75.00
$125.00
$163,00
$375,00
$ 50.00
-'
C. Temporary Services or Feeders
Installation, Alteration or Relocation \.,.,~, ,
"'~ ~l..""" .., ~,
200 Amp~ or less .. ,L \\.'.~:$~5&.ClO'
. ,of \. ,\ "\_\ '
20 I Amps to 400 Amps . ~":. ~"--';"f v,' \-""l69':PO
. 40 I Amp,s t060P ~p:lp.s. ,: ~,.:...~ ",V(,\ \',,\~~,'\$ 1'00.00
,,\\,-,' ",\\...~\\\x., 1,:\'.'"
Over '600~It\P;\>~~/~?~~9.l~Jcie'''B''' 'above.
,.- D. Bradcll~~\~llitS' ::;.r,:' \.W::'~J\0\','
. \W ' \\,'\\.'i~'v, '\(\....'"
New A1tec~~~~~6..~tte'hsion Per Panel
One Circuit'~\ $ 43.00
~ \,
Each Additional Circuit or with
Service or Feeder ~1mit $ 3.00
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergyIResidential
Limited Energy/Commercial
$ 50.00
.2 $ 50.00
$ 25.00
$ 45.00
/eJV
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Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. S[TBTOTAL OF ABOVE
lac::>
I!J
,0
US
8% State Surcharge
10% Administrative Fee
TOTAL
Shared Dlive(T:)/Building Fonns/Electrical Pennit Application I-06,doc