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Permit Electrical 2005-4-21
7)&, ~7UJ9 ~PAIN~~=:; 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541f26-37SV FAX: (541)726-3689 i !~~:j ELECTRIC#;:. PERMIT APPLICATION ' "- City Job Numb';.{}y))..JJrF, _rrt--+=; D Date '7/ :;) { 1. ~ (j"(.f:; - ~., 'I) r--r-~~-;".'::--:-r::.--'"7"';1.-',~.:~"""-"'C. ..~~-~. ---: j-' _ ____:-.".._"'V..;.~...c;>o..:;iS:.!.~-~_ - .---. .~. - ~---:--- 1. t!:O~!IO~OFI1:lST,,,4.L.rjll~N.":~':"::j 3, !.(;Ol'1flfj'i;;,'#liSC~~1ikLOW .." ' ::", ,:" ~ __ __ _ _______~_ -----.~....o-~..!7I)~--- _....__."-' ____,,_...-..A. !(..c,cr <;~,^C)'I~ Ac\Je... "d"..",.i'()';>'~':/~~;:;%"'" ,., .", i '"~ LEGAL DESCRIPTION 0 A, H~I~w'~esideutf~%} OA le~~~~ti",~.!ti~t'<I.~e~Ii~~~nit: .J \ --, ? ".-, 3:> \ a c. ,...-...,,, . -?(9: 9(t,. "">...;... I () ') ,." I '.:::> 1 \l v ServIce Included (f' & '~@ "@(f' ~ / oS'.Q ~ , JOB DESCRIPTION 1000 sq. ft. or less '>';>ti" ~ ~g~ , Each additional 500 sq. ft. or ~@ " /.;>,," 'o/,< ---\-1 Sf\ C::' ([ Q.t \ ~ portion ther~frENTION: Oreg r ~If~"''k Permits are non-transferable and expire if work is Each Manu~t(w>>ndte[Ondopted by 0 on tility ,- not started within 180 days of issuance or if work is Modular Q~eM\n$1l!eIT~l'!ler. Those ru rth Suspended for 180 days. Feeder Ih.OAR 952-001.0010 u"vu~;,;) tl OCti- iCONTRA.Cloitfi&itAf.t.'Xtiofv O~' B. ~.~;':viceP~.9Il~~~iJ~~~1flrJi~{lI~.mm{m:.~~;R4(;;n: ~~i 2. ,"" ",., "'.' , .'v." '. '," <-.1 ' ....::..__calltng:.'tne'cem:ar~\I'lUfe_U1e.lSIUfJUOIl0- --. Electrical con~o~1t' ,'~ It. "Pi p;::t~ t 200 Amps oPM!;'Jber for the. Oregon Utility 1'~9lf1tion 201 Amps to 400 Am<r,~nter IS 1-85e-332-2~:00 ~"" ~Yl( . 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 Over 1000 AmpsIVolts $375.00 Reconnect Only $ 50.00 ". ~.' ~'l ,~". ( . ~ .' ..... . \, '. ~I""~ " ~ - 'I .' { .:':'~\";;,"'- '''CITY.OF~..L AINGFIELD,:OREGON ': '"c .' ",';'. , ,!1 "". ; ~P""" . '. " "'I'..'" . _ . r. ' .'''' \.4",' ..' . ", " '.".' Address ~D City b:::-~ , Phone ~2-1J I.L Supervisor License Number 4-;; B / - <; Expiration Date / tJ / ~ 17 7 Constr. Contr. Number 1.5 Lf"2;;:.rlt. Expiration Date :2/11 I 0 -=r: . I Signature of Supervising Electrieian c. bfe~pof~~~~\K1;~~t~i~PlRi:F TH ~=-~_. _J Installation~ilit~Natiiin:or Relocation,IS PER' 11/ WOHK 200 Amps &(I~Ssr\;!:i\iCE:D Oft,S' 'A~j;\IIl~$ !Vo.OOiJISrNLlT 201 Amps t~f~001~p7i\Y PERlon - ~W.do n 40 I Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" above. r-.......--....-.. -.._-~---~.,_.~-._- ------ --- 0, :Br~nch.Circ\lits'. ' '. ,". T ' . - . - >..___,.._____..:..'_. ~ . , .1 0" ~ tJ A~ ~:: :::tion or Extension Per pane~ $ 43.00 '-13. CJO ./ Each Additional Circuit or with .<? _~O ( I~ Service or Fceder Permit $ 3.00 , ,) OwnersName""t ,:y:;-n ,l JQ.AJl ~ ~_," ~ Address lCo Co 9 ~.J::}) I ..-, ~ C-.... _ od,I.;l'vl.i~c~lIa~~olls(Se[;\'ife(f~e~teri~ot incl~ded) "Ea~h Il'st~~'!.~".nJ City ~i.,j2.f~ Phone 7).. V> _ R ).25 Pump or irrigation S 50.00 U Sign/Outline Lighting $ 50.00 OWNER INST ALLA nON Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 The installation is being made on property I own which is not intended for sale, lease or rent. Inspection Request: 726-3769 Minimum Electric Permit Inspection Fee is $45,00 + Surcharges ~~'.- ,,,,--.,---,..'- .,-- --1 /1; . (5'0 4. :.S~TOT~c2:;fBP~~, ~"-__"C. _,) G.f ~ _ I ~. :L), 4'G.,() .5~~, )( '). 7% State Surcharge 10% Administrative Fee Owncrs Signature: TOTAL Shared Drive(T:}lBuilding FonnslEleclrical Pennit Application )..Q3.doc