HomeMy WebLinkAboutPermit Electrical 2003-8-21
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726,3689 ~a(\h8sth8101l0wlng
olect as submll"" d sa
ELECTRICAL PERMIT APPLICATION ~ Ttletollowlngpr t require spacltlc Ian u
O zoning and does no
City Job Number ~ Zoo3" - 0 C:> 7'7.8" Date '8, CO OAOproval q::{){t .
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1. LOCA110N OF INSTALLA110N 3. COMPLETE FEE SCHEll' TI 10' 1JEf,811' ~-
. Dale - ..,., .
-~t ~>J./L q,,, ,(/1.'-'(0 ')of).) I)/PE' ,,"U\onzed Signature
LEGAL DESCRIPTION A. New Residential- Single or Mnlti-Family per dwelling unit.
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JO~'6ESCRIPT1~N .
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps 10 1000 Amps
Over 1000 AmpsNolts
Reconnect Only '0~*-
~ ~ ~'V"\
C. Temp{l.riI~~Cy;~es or Feeders
~Y., ~~~ ,\$
, r~1all!l~0",,~~eration or Relocation
~v ~'<" ~"
S~~ ~C)O'AQlP! or less $ 50.00
~. _~ ~';:\\)2~b ~~ps to 400 Amps $ 69.00
-;.J xv~\..x.\)~\) I:)~~ps to 600 Amps $100.00
."~, ~~'<-';:\" \)~ 'bver 600 Amps or 1000 Volts see UB" above.
\" '0~ ~'O'V D. Branch Circuit.
" ~'
~<[.: New Alteration or Extension Per Panel 0'> ~~ :0\
One Circuit .,0"''\ \ \\s-l:id,oo
Each Additional Circuit or with ~eo.v' ec!'O" "'e\.... ,,~
Service or Feeder Permit \'lJ.~ 0 ()~ Z,e <1l~1l:0 '" \
,~0~0~ '0'\ ': \,>\0"'Of?-.~ ~ \'>\~(\0
E. Miscellaneous;(SerYlce1'eeder'not'<lncludeill ~li1llch,lilstalla tion
0' 1V' ,\\'- ",'il 0' €I.... :<..~
,,~'\~ '" 'lJ.?:p :<..0\' >is'\0 '~0'" 0 \e~ \~,C?}
Pump'~Nml\a.!iBn(j0(\ .f;Jf;J,f;J.~CO~ ~'~:'$"OO.o
Sign/~utlii\~ 6i&h'til}g~' 0'Q\0-\ \~O', '\~"~~56'~0
\0 r!l\.C"" /~'t ^,' 0\' 0" ~t:"
Limited&,,~rgx1Re~<!enti~~(\" \r;>(S, C'-~ $ 25.00
Limit~f\Q~YI6:Smrife'?cial,0 0 ,.'O\J~ $ 45.00
, ~C!j~' 1i:~~ . \0\ ,. \\'"
Minimum Elec'1'ric e~~\!rJna'J.cllon Fee is $45.00 + Surcharges
4. SUHTOTAL~FABOVE 50
7% State Surcharge :> )0
10% Administrative Fee' SOD
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/2e-6::::, tYd"..:-c.. 'l
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Phone
Expiration Date
Supervisor License Number ~ iJ~
DJ
Constr. Contr. Number
/1
Expiration Date
Signature of Supervising Electrician
Owners Name -Um~.p G"'.......!.l...r::/
Address (.& 5'1.",,;/ AlY"P
City S;OJri''!3f).,.;rI Phone 7'PI' :)~2r-
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
o~re:
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Inspection Request: 726-3769
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. Services or Feeders - Installation, Alterations or Relocation:
i
,
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
"5"0
TOTAL
Shared Drivc(T:)lBuilding Fonns/Elcctrical Pcnnit Application I-03.doc