HomeMy WebLinkAboutPermit Electrical 2005-8-26
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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' >/
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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
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Expiration Date 6\ ~\1.oDlD
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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.
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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'
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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 ,,~,.
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, 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