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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 . Zoning ~/~-;3 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. i7032bZ3> 606og 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 .F58::'::'" '?-i::=t2--./\ (..~ /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: /~~/ L----""" ~;&/ ~/ 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