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Home My WebLink AboutPermit Electrical 2006-9-13 -' L:tf2.- ~I'\A - 3-0~ SP RINGFlriLD . -!::-Spe. ~ \ ('(Ynfl, , J,^----.....y:-~ --=~ '.; , '.." > I."J!,. ,.~' " - ~ ':', ~ "'- ~-12- of. 225 FIITH STREET. SPRINGFIELD,OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION , City Job Number COoN\~ao"- 0077 Z. Date 1. 'LOCAiI~N..oj?!"Sr.AiLATIo.!Y:. '_'.~. ';).ljoq ((o5€ BLOS5olVl LEGAL DESCRIPTION . I 1703 '2 J 1..("1 02-\{CSC> JOB DESCRIPTION t\-JJ. / Del >I" L'^":t, 3. . COMPLETEFEE'SCHEDULEBELOW" , -,'.,," ", . ",..., -. - - ,',' '... . '.;- ........, -,.' - .r" ., - -'-' ~.. . A. L New:'J3.~sidenti~I'",,:'.~iri'gle'or ~'1ulti-~a!nily' r.ef ~~'!II(ng unit: . ..' ,_. ..._>_.. ~ _,_ .._L......."',._"....~...... .._._.+.._.->_,.,'... _ .._~ ," Permits are non-transferable and expire if work is not started within )80 days of issuance or if work is Suspended for 180 days. Service Included 1 000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact" d Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 .<..~.~ '._f'"' . . '_'.~- -. . _ '-.--.--' 2. CQJ:IT10C1."ORINSTALL.A F9N ONLY . . B.Serv!ces ~r'F.ed.rs-lnstallation, Alterations or Relocation: ". '-'-" '.'- --" ".. ---~~~\10:!':::: "J:~'I-~X";rit\(n\t\iO:'\,' --"--., -,' Electrical Contractor nS7SIDE t(EL7~!_~: PERM\ .20? ~nm[.'H '!{ 11~ PE-RMIT IS i\!l) \ $ 63.00 {)\\TUORIZH201~Amps to~OO Amps 0 FOri $ 75.00 "'~-''''3 BS/l/"C ", ",,,lie.- 'nrl\<.:~\<"I\IU,K Address J n....J 0 '--,w'e. '-IV' i,,7""t~ENCE40LA:mps to'600' Amps $125.00 v..," - ,. :)rOlnf"\ ^ ~\y 150 0,601 Amps to 1000 Amps $163.00 City Sp ~(,.D Phone 71.f (-/Y'1Cj Over 1000 AmpslVolts $375.00 Reconnect Only $ 50.00 Supervisor License Number Y7)7s c. }~T~;~~~;rY,.se~ic;s~;'F~~d;~S ,4 ~,,,,,,__,._~,__,_ _ _ io....__. .___ "0 "_'_'''u",___~ _~_ '-,. . "~ . ~ --~'" --.-..- ~ .--- --. .,.~ Expiration Date ID-{- 07 Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 ~ 69.00 $100.00 Expiration Date 1/777() ID'Ol..(- 07 Constr. Contr. Number Over 600 Amps or 1000 Volts see "B" above. ~," ''''~', --.." .......-... '~--'''r'.'",'-'--:-.'..''''''---''- ". ---'.' '.', .-,,-~.. D. ., -Branch Circuits'; ':' -,. _ . . , ....~,.~o<..".._.. -- . Ocr\O-"- -..-...-,, New Alteration or Extension Per PaneJ.(eS 'i . ",\\\\" \ >tI \"'''' C V", li'" One Circuit _ ,. 0(e90\'\ a ,.~ d$e90 $ 43,00(\0 1 ;>,OIJ Each AdditionalrG:i~cuit orL~ith,)j \"(',CJ>S aJe S~n nOI' ....7 00 .,' n-' ~rt"l-' se ~( r$;l3'00 -', Owners Name ~-.(L~ -., ?Il ~~ s,~rv:.c~i~?;;~~~~~~:~(,~~\~~~\~\oe. ~~~;: '. ,', .. Address ;?;" 0 7 l~. E:' I~ (ot:s~. k'- MI.sce.na,neo.ys'!~erYI~e/fee~~r;not mclud~.d)'fEachJ,~slanallon S' f'>.?O --\n'cr-t'o :~\l-~a'i ~~- ~Nb\e"~\~~'~Q\.\\'Iea\\u. " ----. City .,..., Phone "7Zb ,..>8"53 Pumpo.!;lifrlgation\Oecene'e9(\(\D\\ -'3~,59.00 Sign/Outline~~'i~~ting)( ,oe 0(, $(\a-3"j,,"'~ $ 50.00 f'f\\le\ . "'\5 \- Limited Eliergy/ReslsleritiaJ ,$ 25.00, Limited Energy/Commercial $ 45.00 Signature of Supervising Electrician ~~ I~ OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: t-.__, ': "-"". . -; - ~-"'."~."~ ,,"~;"~ - ':--' 4. . SUBTOTAL OF;ABOVE: : l.__.._.,:~+ __..:.....___~. .-_~___ Inspection Request: 726-3769 8% State Surcharge 10% Administrative Fee ( 5'7Fo ~t4- ~ '" ,0 TOTAL .c.) ~ 6-- ,-/ Shared Drive(T:VBuilding FonnslElet:trical Permit Application 1.06,doc 70 56Q 7 ~3"'"