HomeMy WebLinkAboutPermit Electrical 2004-12-28
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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