HomeMy WebLinkAboutPermit Electrical 2006-3-14
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54])726-3753 . FAX: (54];';;;~3~8; zC1lng~~~.a?_VY1q _
I~U5CT1UCAftl'ERMITAPPLICATlON " '0 ---r:r, <. J
CityJobNumbeTl './Jf?7 2fJO(,CJ -()030( Dale (5-'~"/#r.:rr~b
I. I LOCATJOlI' OF J.lvSIA I.LA 110!\'
(7 d() >9tf f()~J '
LEGAL DESCRIPTION
/7 Os :;)s 3q o07(JQ
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JOB DESCRIPTION 1000 sq. ft. or less
/.' /" . <- . ~ Each additional 500 sq, ft, or
UlLl/Ylt:j _ ,.J, t t)f ,., rr.!} ,.(d-~ ~<fl6J$ion thereof(17P8G-G88-008-~ S! Jalua8 $19,00
UO'lrn'l"n., Allllln u05aJO aljl JOI Jaqwnu
Permitfare non-transferable and expire if work is Each Manufact'd Home or 5
not started within ]80 days of issuance or if work is Modul"r'D~~iri;illS1!,!Jic~\W\J) 'JalUaO aljl u!lleO
Suspended for ]80 days. Feeler salnJ aLII 10 sa'doo u!e'M ~'"'' nf)x5~'8ao
, , .- Vl0-C;Sfl 8\;10 lj6noJljl 0 ~oo- ~00-GS6 \:1\;10 U!
2. !: CONTRACFOR. INSTALlATI01\'ONIX B. ! S!lP1~()s:<ir(~'Cr([rJj$:d l;u<t"-lI!.eliy~l~'U!Srati!\~I3t'Jor2fion:
. iilll'ln uoBaJO aljl iiq paldope ::lain! MOIIOI
Electrical Contractor f:-u.<l U\, F:\~ (+.--i ( Q,'N\I I u...200 ~P,~9r\I~~J!nbaJ Mel uoB"'~ '~~~~1ifll!iv L--
, () 201 Amps to 400 Amps $ 75,00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163,00
Over 1000 AmpsNol1S $375.00
Reconnect Only $ 50,00
Address ,\::l C'I >(v")...,~ V"().<L c::.\,.
City .\'=.\,~ c"'.,
Phone ...3.':14 - 7, S".1cl
Supervisor License Number ~ I ~ ~ ~
Expiration Date \ 0 \ ' \ n- "7
Constr. Contr. Number qD ;;) 0 0
Expiration Date .~h-, \ n -,
Signature of Supervising Electrician
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Owners Name l.Ai<t.L1e.r-E'. ~.r<..-r1
Address loRlf" 0 r S"./-..
City 5'rhA Phone 7 2(, ~ h C/2-F
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
3. i COMPLETI, PEE8CmmULE HELOW
, : ~
, . . .
A. I: J'\c~r R{'~:idc[lti::I- Single or ;"lulli-rm~li!~' pto.!: d~\'~llitlg unit.
Service Included
$106.00
C. l''Te~ptJr2TY Se~\'il:t'S ur 'Feeders
InstaUation, Alteration or Relocation
""VICE' ~
200 Amps 9r1less. - -, E Wm:II(
201 Amps t~14!l9l\mp.,\I1IT SHALL t"f ~R ~.b~ IS-NI}T
401 Amps tMo.Q.~ED UNDt:,K I MI" 1~~~dFo;1 ,
Over 600 AiDpsW.i'OoO:fJasQ~ \~,/l.a~~J~U '
D. ' Brantll C/l.Nllil180 DAY PERI D.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43,00
$ 3.00
q lo-cJ
"3
i' . .. '. .
E. ~'1Vi.iscdlan('ow,: (SC'I"\'k(>/fN'dcr not included) ":"Ea.l',b In~tulla,tiun
I ,_., ' , '
Pump or inigation $ 50,00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
,,' .' ..- ,',. ". .
4'I:sum~!tA~~ciFAn()IfJ,i,
8% State Surcharge
10% Administrative Fee
7:';;(~(J7)
'6-7(P
1- -;:)c,
:Ili--Lj < ~
TOTAL
Shared Drivc(T:)/Building FomlSlEleclocnl Pcnnit Application J-06.doc