HomeMy WebLinkAboutPermit Electrical 2009-7-1 (4)
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" CITY OF SPRINGFIELD, OREGON "
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54t)726-3753 . FAX: (541)726.3689
ELECTRICAL PERMIT APPLICATION
City Job Number COM2 007 - 0 14 6 3
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
nuires you to
. mONo Oregon law re", !-!lilit'/..
Supervisor License Number 32 5 7,~;~:~:-,:'^~ ~t\"pted tG. ~~~aV~\'e~es ,(lI:!~eders _ .._ _
'lication Center. Thos ()AR 952.001-
Expiration Date 10/1/201 0 l\jo~ ^ c:- ac;?001-001 0 thrq~''t\lIll\lio~ fb1.t"!'l!y>n or Relocation
'" -. btain CCl)lflS 01 In
0090. You may 0 NotllU ti'1)R~RrPessne
Constr. Contr. Number 22 -15C ,.~lIinQ the center. (o~h~.'1'PS(llil4oot)Q!lps
number tor liTh. or1~004.9'.1:<\ii\Pi4Q.600 Amps
. . / / Center IS
ExpIration Date 7 1 2011 0 600 A 1000 V It "B" b
ver mps or 0 s see a ave.
D. I. Branch Circuits
Pump or irrigation $ 55.00
Sign/Outline Lighting $ 55.00
OWNER INSTALLATION Limited EnergYlReside~b?\<. $ 28.00
The installation is being made on property I "n~ti;IE: l-\li.tt~WI!Y)~o;P~~{S''\401 $ 50.00
IS not Intended for sale, lease or rent. lU\S I'ERM\fi~m\l.'" Elec\1t<: 'j':;r.mi'\\I!!~ction Fee is $50.00 + Surcharges
~I\-10Rl7.E'4D~JE~~3~'?lli~Ji?"- - ~.--~ 78.00
COMMHICE ~ p~W.Sthe s;,~harge -- -... ..- -.
AtW 180 01\ 10% Administrative Fee
~
1. I LOCATlONOF INSTALLATION:
LaneC & 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 CONTRACTORlNSTALLATIONONLyJ
Electrical Contractor E C Company
Address
32758 Old Hwy 34 SE
City Albany
Phone Oreqon
Signature of Supervising Electrici:m
2 )J2Lj( J{>~
Owners Name
PeaceHealth
Address
City Springfield
Phone 335-2817
Owners Signature:
Inspection Request: 726.3769
SP.'ECD --::I
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ZON \I\llU
INITIALS N V"'-'
DATE "1-I-CJJ1
SOURCE ~ () V
Date 6/19/08
3. I COMPLET!'FE!!.~CHEDULEBEI:Ol:!'
A. I New Re~~,,!illl.- Single or .Multi~Family per dwelling unit. .J
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
$117.00
$ 21.00
$55.00
B. I serVices o,r F::..~ders - ~~Ila_t~on, Alterations or Relocat~~J
1
70.00
$ 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
J
$ 55.00
$ 76.00
$110.00
___ ___ J
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 48.00
$ 4.00
2
8.00
E. r Miscellaneous (Service/feeder not inCluded) ~Each Installation I
1.-_ .__
9.36
7.80
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Shared Drive(T)/Building FormslElectrica\ Permit Application I-08.doc
5% Technology Fee
TOTAL