HomeMy WebLinkAboutPermit Electrical 2007-8-15
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CITY OF SPRINGrfELD, OREGON
22S FIFTH STREET. SPRINGFIELD. OR 97477 . PH:(S41)726-37S3 . FAX: (S41)726-3689
ELECTRICAL PERMIT A PPI.lr.A T1()N ) /72-
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City Job Number
1. I LOCATION OF INSTALLATION:
Medica..! . Offioe.. Bu i Idine.
LEGALDE~CRIPTION: l"03~O<r'OO ~o)..
_ R\\IUD~ Medic.o.l PCl\Jlliotv
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JOB DESCRIPTION:
Cove... <t S,1jC/."'\ \
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. ! CONTRACl"OR INSTALLATION ONlX I
~PAIN.D occ-~ c:::; ZON mil (' J
: . j'cr ~ _ .../'-...1 ~ INITIALS N Y\'\.
I ~----'..- i DATE 'K-\S~61
I ,,-, ~~ SOURCE~
Date
~-14--0'7
3, I COMPLETE FEE SCHEDULE BELOW
A. I Ncw Rc'Sidential- Single or Multi.Famil)' per dwclling unit,
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modu)ar Dwelling Service or
Feeder
$117.00
$ 21.00
$55.00
B,I Services or Feeders -Installation. Alterations or Relocation:
E)ectrical Contractor \=-c. Com'pt'l1\'1 200 Amps or less 3'1 $ 70.00 2,7:30 -
20 I Amps to 400 Amps ~ $ 83,00 315'-1-
Address Po Box 0,1..".> 40) Amps to 600 Amps Z. $138.00 2..,6,-
601 Amps to 1000 Amps 3 $180,00 5L10
City .Alnn.Y\\.1 Phone !N\\C\U,-Lj2f..b Over 1000 AmpsNoIts z.. $413.00 '82.c,,'
. Reconnect On)y $ 55.00
c. I Temporary Services or Feeders
1\I0TIC~:
THIS PERMmI3W11tMi,\qall~~~a'fm~tt
AUTHOR@ilIMl~BElt.JHIS PERMIT IS MOY
~OMMENef~t6$db~ONED Fuit
ANY 18a'PJIM''VIi1ill0~ Amps I
Over 600 Amps or 1000 Vo)ts see "B" above.
D. I Branch Circuits
Supervisor License Number
'~i2.515
Expiration Date
\0 -1- 01
Conslr, Conlr. Number
l1C1131
\-1<:> -0'8
Expiration Date
Signature of Supervising Electrician
tJ~lr0-9
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Owners Name Pe.ac..e.. \-\~I+h
Address 3~3'2., l'1CUY\ll_ FaNrn Ih\.
City --.S.p' i n~~.p~ Phone (SCl(\ "I'i!"i'-12Yo
$ 55.00
$ 76.00
$1)0.00
1\6-
New Alteration or Extension Per Panel
One Circuit I
Each Additional Circuit or with
Service or Feeder Permit
$ 48.00
$ 4,00
y~-
~'-I'\I;-
137
E, I Miscellaneous (Service/feeder not includcd) -Each Installation:
Pump or irrigation $ 55.00
SignlOut)ine Lighting $ 55,00
OWNER INST ALLA nON Limited Energy/Residentia) $ 28.00
The installation is being made on property I own which Limited Energy/Commercial 4 $ 50.00 LbO -
is not intended:fl>'I'~ffleft.'\!)ffillon law l'GCjulrOO ~imum Electric Permit Inspection Fee is $50,00 + Surcharges
o S' hllow rules adopted by the OregOll,lml!i17i SUB1"OTAL OF ABOVE --~- ---r .. 4 3'2.-
wners Ig9a~l1hcalion Center, Those rules are sI'J2 fd i lJ
i . nAI'l o"~_nn1_nn'nth",,'{'h OAR 952.(ll)~o 8% State Surcharge (;,145..
,)090, You may obtain coplesofthe rulso IlV 10% Administrative Fee 'i'$4 ~"<.U
calling the center. (Nole: the 2\l1ephono 5%,Technology Fee 4 '1.\ ~o
number for the Oregon Utility Notlfio::l2\Cl:iil Z5~, Plo..n 9.e.\lI"CU) F<<. 2. lOll'
Inspcction Request: l.t<h!eP~s 1-800-332-2344). TOTAL ., 12.41"1. ~
Shared Drive(T:)/Building Fonns/Electrical Permit Application 7-07.doc