HomeMy WebLinkAboutPermit Electrical 2007-4-10
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i JII. INITlALS
~-A!. DATE
.-... 'lIIIJI' SOURCE
225 nITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (S41)726-3689
ELECTRICAL PERMIT APPliCATION
City Job Number aO~;ZCV7 - CX)~07
71')0/07
Date
I. I LOCATION OF INSTALLATION:
3333 /?:J/8~I()/} /J~.
LEGAL DESCRIPTION:
/7/03-22 Tt-. (oaJ/ IPO; IltZJ
JOB DESCRIPTION: _
r/./STIft..t.-47?,tlA.I Of F/g~~ O{/C75
As /'#/27 Or (7AJ&ttt1UllC 7lI~ /A/5/1/I.J;aJ
3. I COMPLETE FEE SCHEDULE BELOW
A. I New Residential- Single or Multi-Family per dwelling unit.
Service Included
$106,00
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dweiling Service or
Feeder
$ 19.00
Permits arc non.transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$50.00
2. I CONTRACTOR INSTALLATION ONLY I B. I Services or Feeders - !~~l1'U\';l.!l>iQ Alterations or Relocation:
_. non laIN 1""10\. . OD Uli\\W
/:::;/ecfYIG "'''1~QO,\r.\@p~ or les~f Ine 0le9 5p,Iorln
/,-11 t:.'" .<n,,'eO u, \ 5 are ,
IN ru-tei., Amps tofP.l6b!f1PS e 1'\ 95?-00 -
SK 10\10 \11101C'Am/fs'to 600,Ampsn O/'-", ("IRS 0'/
Nollllca "r,ni-OOW"'" ;;"oll"e
. . O/,-I'\ SQ.Ol AmPA~'lJ\~PQrKriIps lele\lhODe
Phone 7 2,.(p ~S'"'f'\ 90 'i.9yef\Tb'OO Amp~.(Volfli. Ine Nolllical\OD
00 i\IDR"!'onntfcrO~Iy.90D UII\I\'! 44)
ca \)~, lor \ne U\.~ ~"n_332 23 .
Dum r _~......l I';:; , J_
C. 'temporary Services or Feeders
Electrical Contractor LlJp.,;...
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
~
,
Address 345' 3 J
but;Ute.
City
3'19'2 S
Supervisor License Number
ExpirationDate 10'3/-08
Instailation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
g'-107J9
7/;'4tI/o
Constr. Contr. Number
Expiration Date
Over 600 Amps or 1000 Volts see "B" above.
NOT'lD'r.~ Br~ch c,irc~XP1RE-IHHE-WORK
THIS PE!liMPA~r..~tiil-n o~ ,E~tens~P'\ferH\a}!6T
A.UTHOrohEl2i~~lpEK I MI::J n: 'p.' $ 43.00
COMMH..:S@daffidtl'alrm~mlWtl.ft~ fO.,
ANY 1 sB"ii"Ac,e P't!!~ro~ Penmt $ 3.00
E. I Miscellaneous (Service/feeder not included) -Each Installation I
Signature of Supervising Electrician
;;'~ .(~
Owners Name ff-/fta/lIEA/.-.TH
Address /26 1:/f/Ttl2A7/I.?IUi/1 WilY
City SPt2/AJvPl6.UJ Phone .~- z;t!7
9:;W77
OWNER INSTALLATION
The installation is being made on property [ own which
is not intended for sale, lease or rent.
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial / $ 45.00 l../ t;. DO
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. I SUBTOTAL OF ABOVE l{ 5. DO
8% State Surcharge 3 . u C)
10% Administrative Fee '-I. . ~f\
5% Technology Fee - Ij Cl--<)"
J-<)Olb fllA.l'll-t-oJlU-....; " .:;<)
TOTAL Iif~ "" D
Shared Drive(T:)/Building ForrnslElectrical Permit Applica IOn -06.doc
Owners Signature:
Inspection Request: 726-3769