HomeMy WebLinkAboutPermit Electrical 2009-7-1 (3)
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541)726.3689
ELECTRICAL PERMIT APPLICATION
City Job Number COM2 007.014 6 3
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1. I LOcA"1'ION OFINSTALLAtIO^,:~~]
Riverbend & MLK
LEGAL DESCRIPTION:
Monument Siqn Service
JOB DESCRIPTION:
3333 Riverbend
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. I CONTRAcrORINSTAiLATIONO~~Y J
Electrical Contractor E C Company
Address 32758 Old Hwv 34 SE
City Albany
Phone Oreqon
Supervisor License Number 3257 S
Expiration Date 10/1/2010
Constr.Contr.Number 22-15C
Expiration Date 7/1/2011
Signature of Supervising Electrician
t
Owners Name PeaceHeal th
Address
City Springfield Phone 335-2817
OWNER INSTALLATION
The installalion is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726.3769
8.,,~,ELD,
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INITIALS NtvI..\
DATE 1'1....0'"
SOURCE en P~)
Date 6/19/08
3. r-COMPf:.Ef..l!f!!-E SCHEDULE BELOW -'-__J
A. I New ResideiItial- Single or ~.".'!~Famil; per. dwelling unit. ]
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Horne or
Modular Dwelling Service or
Feeder
$117.00
$ 21.00
$55.00
B.I Services or Feeders -'1ns~allation, Alterations or Relocation:
200 Amps or less 1 $ 70.00
201 Amps to 400 Amps $ 83.00
401 Amps to 600 Amps $138.00
601 Amps to 1000 Amps \^ $180.00
Over 1000 Am?sl'}p!teo.uileS 'iO~t\\l~ $413.00
~~,\n't~cl,QiiIy la \\'Ie OlegOl1set .nf\!\ $ 55.00
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40 I ~lIlp's to 600 Amps
70.00
..J
$ 55.00
$ 76.00
$110.00
Over 600 Amps or 1000 Volts see "B" above.
D. I Branc;'- Circuits
~ --------_._-------
~---- - ---.----,
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Penn it
$ 48.00
$ 4.00 8.00
2
- ------..,-- _ _ _ -- -- 1
E. 1 Mtsc~llan.eous-(Servi~e/fe~der noi.includ~~'Ins.tallatiOn )
. P\V.~ \1" ~ ~c:.'t.lO'
Pu~~f.;lion\'t $\'\fo.\.\. ~ S \'t.~lJI\\ ~J1J
SigIlf~~~i~lih\l~nEV. "{\,\\ ~il~oiw.oo
Limi\i.e~&~I\S f>.~~l $ 28.00
Limitttl'~~V~\il\On. $ 50.00
Minimum E~"Ii'ti4 %~WThn~ection!.ee .is $50.00 + ~urcharges
4. I SUBTOTAL OF ABOVEj 78. 00
1-..-____ ___ ___ ___ ___.. __ . _ _ _ _ ___ _
12% Stale Surcharge 9 . 36
10% Administrative Pee 7. (jO
5% Technology Pee 3. qt)
930"
TOTAL 9;.J6
Shared Drive(T:)IBuilding FonnslElectrical Permit Application l-08.doc