HomeMy WebLinkAboutPermit Electrical 2009-7-1 (2)
.
ELECTRICAL PERMIT APPLICATION
City Job Number COM2 007 - 0 146 3
s,~
215 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.J75J . FAX: (54I)726.J689 ~. .~'
SCANNEDe 6/19/08
ZON 'rY\v..U
INITIALS t-J(\/\
DATE 'tJ,.- I - 110
SOURCE ~
1. I LocATION OF INSTALLATION:
Cardinal Way & MLK
LEGAL DESCRIPTION:
Monument Siqn Service
JOB DESCRIPTION:
3. I COMPLf!!.1!.!BE S~HEDULE BELOW
__J
A. r New-R-;;sid~~tial- Single or Multi-Family per dwelling -uuit.
Service Included
3333 Riverbend
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$117.00
$ 21.00
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. lCo..NTRACTORINSTALLATIONONLY I
$55.00
B. I ,Services or Feeders -ln~taIl8tion; Alteration~'or Relocatio"_:
Electrical Contractor E C Company
City Albany
Phone Oreqon
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
1
$ 70.00 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
Address 32758 Old Hwy 34 SE
Constr. Contr. Number
22-15C
C. [Temporary ~et.~U"(~eeders ___ ,.
c '0" '20Y"~ Uti\it"
..". ""0"'';'''' ()..ooon 'J.
.".... \; "Installstio&, }\:lterat'9n~Q~'Ritlocation
)\." "ruIPS art;;.... ,
r I 1200,Amp~ or,less)l.R 952.00 . $ 55.00
" _ 20 Il'Ain'c;l\g 100 f.\nips.lles '0'1 $ 76.00
".l", ',;" clbple, -' .1. n\1one
I' 'i>l (401 Amps to 6QO i\:m~ fon $110.00
-: . ",' cenlel. l\WI:'I;;~.~%\liCa\
. "." \"e 11 Ov~O,O\Amp'S~<Jr '.t}'O Volts see "B" above.
[.un\ber lor :o~t'''r8J,nc'fr't1r~uits .
cen,,"\? . .
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or wilh
Service or Feeder Permit
I
-I
-=- ....J
Supervisor License Number 3257 S
Expiration Date 10/1/2010
Expiration Date 7/1/2011
Sigrature of Supervising Electrician
--.-J
~jr(IJ ----/l a_3-.__~
$ 48.00
2
$ 4.00
8.00
Owners Name
PeaceHealth
E. I Miscenanebus (Seh,ice/feeder not included) -Each Installation
o ... iut: \NORI<. $ 55 0
:T\Ceump or IrngalIO~~R't. If nt:. 01 . 0
NO E.i\~sWe\J\iJi;ti p't.RWlI1 IS I~ $ 55.00
iHIS PO~~l3~I\tl-~~WA~'l)ia~EO fOR $ 28.00
The installation is being made on property I own which )I.\JTH ~tJre~ JOlilr~/~mercial $ 50.00
is nol intended for sale, lease or rent. Cq.fMII)!~~,F:I'qfaRlQj:h,it Inspection Fee is $50.00 + Surcharges
ANn~~~~TALOFABO-VE . -_.. : 78.00
Owners Signature: l___________ ~ +_,__ ____
12% State Surcharge 9 . 36
10% Administrative Fee 7. tJu
5% Technology Fee 3. <(t)
~.0fR
A'1 ~6:.
Shared Drive(T)lBuilding FormsfElectrical Permit Application I-08.doc
Address
City Springfield
Phone 335 - 281 7
OWNER INSTALLATION
Inspection Request: 726.3769
TOTAL