HomeMy WebLinkAboutPermit Electrical 2003-8-8
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAXr~aOa~fillllecl es submitted has the following
ELECTRICAL PERMIT APPLICATION zOning. end does not require specific land use
, ./ _ / approvel.
CilyJobNumber CO...z..oo3-00Z.0,-/ Date 'b/S/o3 loninr J't\Cl...
I I &f/l)3
3. COMPLETEFEli~'tnn.uvLLD.cL;:"~~- not'. \
Authorized Signature -, ~ k..I
~\o
C. Temporary Se{(tieelO~~ders
>II (eo.\} e~,of\ e\ ,o~
InstaUalffin\~~~ati{)J"S'ro;Il.cfo<;lation
.l\.6':l- ~'l" ~e'O- 09'" ~ \
, ,\...,\wo~ps ~esl; 0"''''' tu\0 $ 50,00
\ \V AOO ~y\0 ..(\~ \'r'-0 ~'"
,.., Y,~ ~e'i> ~'i~#,lps~~llO,!'~.PS e9'r'-0.~" $ 69.00
p.~~o>l'ltU r-G'40'l~t?<,6.011\~\e\ ~\~\c~\~ $100,00
\0' \\0 r..0" ,o;,.\fI, \e'.' ,~o
~'o;t:",~.~ ",~'2."oveJ{i!Oo AOlp~or.l9"liO v.<\~see "B" above,
,~" ~ '" {(\'~, \0';'.n \I' rt:r
.~O'" '{O'D. ~BSll~ch~~lli~'~~'2.'
, 90.. ~\~ y\eU ?,OQ
QO c~\,(\ ~tW"j\I\,,~.ation or Extension Per Panel
fluf'l'oe O!1e~~cuit
Each Addilional Circuit or with
Service or Feeder Permit
I.
LOCA110N OFINSTALLATION
8/f'l i!., "l::'<L
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Wy
LEGAL DESCRIPTION
/70-;s.Z3'-f3
JOB DESCRIPTION
LoW I/o 1-fA-,tC let::":::'
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
/1300
2,
CONrRACTOR INSTALLATION ONLY
Electrical Contraclor OrJer~{ fud ;;}'fnfrOrL"c..s
Address
v O. Ao>< '-(DS<.f?
City ~~ ']7<{llofpilOne Lfglf- 9077
Supervisor License Number
'!J9:93 L-G/4
Expiralion Date I D II los
Constr. Contr. Number / L( '-( (Pf S '
Expiration Date {, -
:JJJ1Jt'
if
i
ctrici 10
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Owners Name ~ -L...rc 'E J", <...
?O 'Eo, 71.fZ-S-
Address
Cily e/ll..&t:7V' ~ Phone
OWNER INSTALLATION '
The installation is being made on properly I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Rcquest: 726-3769
A. New n('sidcntial - Single or Multi-Family per dwelling unit.
Service Included
1000 sq, ft. or less
Each additional 500 sq, ft. or
portion thereof
Each ManufacI'd Home or
Modular Dwelling Service or '
Feeder
$106,00
$ 19,00
$50,00
B. Services or Fceders - Installation, Alterations or Relocation:
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
$ 63.00
$ 75,00
$125.00
$163,00
$375,00
$ 50,00
$ 43,00
$ 3,00
E. Miscellaneous (Senice/feeder uot included) -Each Installation
Pump or irrigation '~Q9..~ $ 50,00
Sign/Outline Lighling ~ '\\\'t.' "1,(\\ $ 50.00
Limited EnergY/~~r~~\'\ ~~ I $ 25,00
~ited ~~~0~~~~"I\'t.\) ~ $ 45,00-
'\~~~%'i!ft\P'e\~~~~ction Fee ~ Surcharges
\~\~o-l!\~X~~ .
~., X~O: n . OVE ,....
~\) ~,,~'i" ~ y::i
c,()\" Il,\) \) I ,-
\>.\~ ~lfle Surcharge :5
10% Administrative Fee I.f S~
P s z (;,S-
Z~
TOTAL
Shared Drive(T:)/Building Fonns/Elcctricnl Pennit Application 1-03.doc