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HomeMy WebLinkAboutPermit Electrical 2004-12-28 SPJ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . F~54I)7~~.9 ~K',.~ ELECTRICAL PERMIT APPliCATION l'v~ ~~0: ~ 00:.'9-.; . . '., City Job Number CoMA ~~o"_c>I5>f{g Date I z.-l. f!r -0'1 0., o~.;. "'" 0,.. ,,,, €-'-' -r ~(5) :9 0" iJI 0' _ \. ,..~ Il}h 1. I LOCATION OF INSTALlATION 3. I COMPLETE FEE S.:iW~EL~~ . I L./I f{ 12"'E'L If, t:vJ ?lv.J 'v,~. '. ~ '\: ~~o;..",. LEGAL DESCRIPTION A.I NeWResidential~Singleor~~Ultl ~~. O~8Ii.~gnnit.. I 7 0 "3"3 L{ I L( 0 l{ (0 0 ,Service Included C v"'.. ""~ JOB DESCRIPTION I 000 sq. ft. or less fL $ 6:00 Each additional 500 sq. ft. or '\. ~ St:-<2-vl(K' f2cIJ::,^,^e::-r...:l portion thereof '\. $ 9.00 " 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. l cONTRAcrOR INSTALMTION ONLY, I I "rlA,}1 .f Electrical Contractor p,. C l1'">-~JV-v <e.t.a.c.fltli.. (J, c) e'lJ Address "2c,q City 1.,if'A-\~"'Vj' J~ Phone 7 t( '(--o '10') Supervisor License Number '3 (o G~ - S Expiration Date '7/, 0 /,., Cr .L 3C.l"';S~ Constr. Contr. Number I -. Expiration Date '7/, % G I I Signature of Supervising Electrician Lq, ~fd! t.-A-N c;-. 12., vc-<l... I/,CvoI jJ /"CJ Owners Name ~jULy Address 4/ Y City <:.;)F ;\ Phone OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 Each Manufac!' d Home or Modular Dwelling Service or Feeder $50.00 B. I. Services or Feeders:- Installation, Alterations or Relo,cation: 200Amp~o'fies~\;:T SHALL EXPIRE IF n$F6j~~RK 201 AIhpsti6'400l\\ti~J"'Df:R THi::> t"tn;vili 7?o'OOi 401 Arnps.!,!'i;oii'A'rRp0R IS ABill~UUIRO$12's~00 601 A^ri1p~ tbli'oooIA'l$f-HIOD. $163.00 Over 1000 AmpsIVolts $375.00 Reconnect Only $ 50.00 <;"0 c. I TempQrary Servic'lS or :Feeders I Installatlou, AlteratiQn or Relocation 200 Amps or less $ 50.00 20\ Amps to 400 Amps $ 69.00 ATTEi~~It"1l1s~r~lI?.:t.\~1 requIres you to $100.00 NfOtUDo~?r::Bet:~Ohl~~IP'if6l1rt",~. ~!~~~~~:~~~f~~t: o I .q'. rane \!. rcu:s ..' a gM in OAR l:l52-\IU1-llU I U ;;" uu~~ DMT!J5 '. ' . 0090 ~~~~~all3!aWi ~~~!"8fl!!;1alltJIgG by l'If?1in"prc~i~nte{. INqte:.the teleohone $ 43,00 ca Eacli,f}.,lIdLti~'I'l CirCUIt QI' with I tT r n nurri;l!i'Vil:'ero~ Feed~~WM,l/II\Ily-r.O Ilca 10 $ 3.00 Center is HlUU-;j'32-2344). E. I )VIiscellaneoits (Service/feeder not inClu<Ied) -Each In~tallalion I Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4.1 SUBTOTAL OF ABOVE 7% State Surcharge 10% Administrative Fee 50 )TO TOTAL ~.:> 5;"8 ~ Shared Drive(T:)lBuilding FormslElectrical Pennit Application l-Q3.doc