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HomeMy WebLinkAboutPermit Electrical 2005-8-26 I . ~ .d" 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX.;,(Sftl)726- ELECTRlCALPERMITAPPLlCATION ,,} , I_/, "Q0'''~ City Job Number COtAAz.cotl'. 01'1'''' Date 'l Z'f!C>S' >/ I. ~fL.~(j1'{.(j!3iINS'fA..tT:4iJQI'P,~1:',-','fJ 3. ~g.:rMf.4fiiJt$'.~~l@~Bj:liQ~*~.;:~~,{~;~.j},;;ii,~ 4 to \211l€1't IJl(:LN 'KIll.!. C:>S7CO A. t;~~J~~id~ri~~:sl1t~ie~o~~.Mtiltii:F~iii:~~;'a*~ili~~g'::i::wilffis";;': ~_.-!1:~_.. - "-_.....<.~-...,-- .-'.- -...",'-.,'-_"'.. .. '",'''ff..~.~..:::t: b-'- ," r Permits are non-transferable and expire if work is Each Manufact'd Home or not started within 180 days of issuance or If work Is Modular Dwelling Service or Suspended for 180 days. Feeder t?~;;;~~;:;s;.(jf(jR~iNST$1.{n~,nON. iONLY.;,i B. 'l~}hii~~for.'~ii'fi.~.Jii~ti.'fl~ti~.n...:"~~lteHi~ijlii~~.'f~~i~a1i'~~.. ~;1/.',~ 2. ""","">llll"k""'''"''' .';cl., ','c~jW''''~. ~ c. <""'N:'~Ore,gon I~i'e((llil~; '. ,c."'''',. ...."..A -'-.- ."~.: 'c" "-',' .C" ..,"j Electrical Contractor "l:LhlA~ \ o.\~?-:2l e.~l;!. ~dWn;ps'lltQ'n,!Jtllity $ 63.00 N u'.':.. ;i~~ Center. ThaD~ Jl(tlrp'S iNrroOeA~~1h $ 75.00 Address "131-\ z.. 1.:6d, cme.." (\(\~.0010tt40ll~~/i;fl;Ob'iAin~s' $125.00 &I~ ...".. '~....- m. a~obtain '6OPWil1p$ftbhl1)b\\I;;.~t ..~ng $163.00 C-, " .' ,.... (t.,to' ,....0. toleohmlt:t City ~~. ~~ Phone ~,'.,C'o..1ter, 0ver'10uuAmp.S!VOlt<1 $375,00 .J '. 0 ~ I 1~:l;hl 1':000'''''I.illCCll101 number for the reg<Reconnect. y $ 50.00 " I' \ '1 cCenter is 1-c80~:,~:.::4~)~,~".,,~~"..",;, "d'""" .', ''''''''.' c'<,~.'ij'.4'h""C"'"" ,',$1< Supervisor License Number L- \, L- ....) . ~mp(J~J'Y:~.r:yIC:esL9~-.I:,~e. ers1i:"':",~.'':.,,"M.J;fi~~!'.,:,:.. .~'-~: ttl.;~1~,~~,,~'1 10/' /'LOt)1 . C\DTL~ Expiration Date 6\ ~\1.oDlD ';~v'72t,.;. (' LEGAL DESCRIPTION /703"3. LfIL( Service Included 1000 sq, ft, or less Each additional 500 sq. ft. or portion thereof JOB DESCRIPTION ~ cl6 J c'l r G<.o\.-t 4- " Expiration Date Installallon, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 40 I Amps to 600 Amps Constr. Contr, Number $106.00 $ 19,00 $50,00 $ 50,00 $ 69,00 $100,00 Over 600 Amps or 1000 Volts see "B" above. D t~B'l.qr-, 'hi;..~t!--. '';is.t%-~1~;,::,t-r:', h ~'-j"';' i ,: r;,-i'~~r.:..f7"'c'-v"'.b<~~}\''r 1<i'Jif-"'":":I . t---~!I~-_.~~~~~~!~':;0.<' :.'1.......\;.-:.. :;:~ ':'ti..;.,:,f/' !-.:~~;.' ._' ':i~c~ Owners Name lCA/2..L.A SM /'tH Address 4 Z-O ~ V t::(LVl~W S ?~ Phone 7l{lf - 2S" ll. New Alteration or Extension Per Panel One Circuit J Each Additional Circuit or with Service or Feeder Pennit $ 43,00 Lf1 b z $ 3,00 E. ~M~~lliilie~iii:r~iMt~i~d~r)1no1~ditd~as~Eia.~rriitlfil1itiJD' ~.."'_.. ............~.." ~~..., ,.... .."""--~,,,--,,,,,, .. ~ '. ''''"''=~~'; -i;:"'. -'~;1--<-"'" .~~.,.....~.:.. \,':.:~ Pump or irtigation Sign/Outline Lighting OWNER INSTALLATION Limited EnergylResidential The installation is being made on property I own which~; ~",".:: :I;imited Energy/Commercial"HE \"::: 111' , , ddC II . ,..-~I",lrXI'18E\rl IS not mten e lor sa e, ease or rent. 1 h. 'IMinimum Electric Permit.Inspection Fee Is 545.00 + Surcharges ..... - ~ ." r.f n '-~IS r'I,n, III IV ,,~,. \LJ 11'1'''~'''W'''''''''' J".H.,,,,,,<'\,t:<,u;"".,1;;'.l">"i''''-''''iiil lj Q , 4. ..'Sv.o:a~O':I::Jt7i"(IlFJABO.'VE!i:.t?:{~.,~g!~".,~ ..,,'~,,~~;~p=;r2~ , C C :, .: \ ~.' ~""'~"1~;-t "'-:l,~.,_~~~,~t7'>;i!-~'~'!:~'~ ': ~~~"'::i;:i of". t .i-:"-;'~~~ "NY 1 07%'sI~tnu~di;Wge "31/3 10% Administrative Fee l{ '0 57 3'5 City Owners Signature: Inspection Request: 726-3769 TOTAL Shared Drive(T:yauilding Forms/Electrical Permit Applicalion I-OJ.doc $ 50.00 $ 50.00 $ 25.00 $ 45.00