HomeMy WebLinkAboutPermit Electrical 2006-12-12
, 0: J CITY OF SPRINGFIELD, OREGON' .
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225 FWfII STREET. SPRINGFIELD, OR 97477 . PII:(54t)726-3753 . FAX: (54t)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CO".tA'ZOoU - 0 Il(f'!
I. LOCATION OF INSTALLATION: 3. COMPLETE FEE SCHEDULE BELOW
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2.
Electrical Contractor C/.l<:..h <- J 41 /(y 6.fcc:l~,<' 200 Amps or less $ 63.00
. ~ "I/.-;
_ ' 201 Amp~~o4P.,,2 J\.~s $ 75.00
Address q:s I ~ 5 t-J rv /"" /:'\1 S 401 Amils fO~&lbmj1v1i $125.00
( 601 M~ft6'~()1~4j.o. $163.00
City B C'AuQAo...J IY Phon ..,o:~) "':Jf - 4' 6 0 Over ~&(16 ~6\!ll ~ob<-/(;.9. $375.00
I =-y-- , R~~61?rYh '00 &,,4;>, :ro,&, u;. $ 50.00
o?6~~~';~ 7-a :':-;;.'0'6 '<f&z"
Supervisor License Number ').11/ C. t... En. c. Tem""f1;~ s'l!lvl~1d1i{dSr.~& 1"&9~.
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{r/ Installation!/A.lt.Q4tioRl1>r~o'llilit.;"ls-... ~o.,^i9'y'o.~,
Expiration Date I () - 0 - 0 IS ~ l' ~&;l "0,,-"$ 'Q v~ .,,,~ v~_
4'0 200 Amps or less 19a 0"",&"" IS' O~ ~~ &,(\$'5112lUJ
Constr. Contr. Number I '-{ 'i' ;2 .::t. ::L ~, ~C! 201 Amps to 400 A,,?p3'<1~~~~ I' 0~' ,gS"l'f~~t'fo
c. 'Y<:/');'0;.o<s '?;. 401 Amps to 600 Amps ~~ ~'i'61'l~ "'4-~~~0
Expiration Date 7 - 0 (. - 6 '1 0, 0r/) ~L ~ "-1/::' . '12.....6'6 7
-,~ '/~ 'J% ''7/):' Over 600 Amps or 1000VoIts.~e B~~~",~
Signature of Supervising Electrician rl'6'O'f'~C':f'o (/, DJX Branch Ci~cuit~ _ _ _ ~
j) /J VI_ /J 01' <? 0. :PO~(W ,Nteration or Extension Per Panel
-tCrrr 1(1/ /,~ rA?> <r <'Ohe.tfrsuit
h h l. '00. ~~&dffi!ilJI.!al Circuit or with
~ ~ ",--(' V 'Sejl'ice~,F~95rPermit $ 3.00
Owners Name c;;-o- . ~ -rr ,.. . Va ~4", ~ ' _. _
Address 70 ,'Z --,.r I" 7 '7 E. Mis~an~~~M~iCelfeeder not included) -Each Installation
'v~<.)~ '1'1" - - .
City f:--u. (-611' E Phone Pump or irrig~on <?)' $ 50.00
SignlOutline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial "3 Z. $ 45.00 lit" 0
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.: SUBTOTALOFABOVE - ,- !l{I/O
-- ++-.....
8% State Surcharge IJ S ~
10% Administrative Fee I L/L/
5% Technology Fee A "L^-) I _ 7 L
T ZS% fINlUvllw ~.;><7"
TOTAL $ZI"3I~
Shared Drivc{T:)/Building FonnslElectrical Pennit Application 8-06.doc
LEGAL DESCRIPTION:
/70'5 2ZC> C>
60 ?O2-
JOB DESCRIPTION:
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Permits are non-transferable and expire if work is
not started within 180 da~'s of issuance or if work is
Suspended for 180 days.
CONrRACTOR INSTALlATION ONLY
OWNER INST ALLA TION
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B. Services or Feeders -Installation, Alterations or Relocation:
$ 43.00