HomeMy WebLinkAboutPermit Electrical 2004-9-28
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: )726-~~ '>6~. ti, "-
ELECTRICAL PERMIT APPLICATION "Ivll,or.. "9 '1v;': ;/f?~ ".
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City Job Number CPM2.0D;3-D/tJ91 Date q Z-3 ZOO, "'8,;, %t.~&lo{J
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1. I L~CATION OF INSTALLATION 3. I COMPLETE FEE SCHEDuutBlZLO~~ ~ r
3Z.b3,2A:(gc;c-"u./Cz)d. ~~ ~
A. I New Residential- Single or Multi-Family per ~ini\h.it.
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2. I CONTRACTOR INSTALLATION ONLY I B. I Services or Feeders -Installation, Alterations or Relocation:
IGW roqUlfW VlW t<,
Anarn~.:.,3Wf~I/fl9r0m90n \Jti!iil/
~Gi:J~ ,,"uOp Al\~mfu~ f~
W~nn CQnt.oa~bWOOtg~0tA1tfp~~-
tn OAR &M.oo1 ~rNlw/litli>1 OMl"A~p'~~ 1'fJ.:[!
~ V'cwMSV 0 ~llifJhO~
@Bl!:Jtl:l \:llO ~f~lY NotilicmlQ{l
~~~ N-aQ~-3~.2344)..
~t:t:l Temporary Services or Feeders
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Each Additional Circuit or with...., q
/?. _ I / .A-<Jr~, Service or Feeder Pennit ...:> $ 3.00 f
Owners Name 5-'::ln-f~ I( ~'lv~..Jn~E: -'AFlf.!: If "~F WOR\{
Address ::S2h ~ i2At:%dtEr.J.tJ)oo!::> THIS PERM\E.~lsh~.!IIl!!~\l.~'i\\l1'.w.,&lIQJnot included) -Each Installation I
IblORIIED lJl"~E.[\ r ,nl\lEI> fOK-
City SPI2,tJro 1=1 ~L.DPhone ~,,-A~ .r,i~Et-lCED~VlJi'OrM\iJl\grl" $ 50.00
v \VI 180 Ot>.~oo..e Lighting $ 50.00
t>.N'{ Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
LEGAL DESCRIPTION
/703. Z,Zi 3-
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JOB DESCRIPTION
.11'iC?C? .
,4:00. /,k THl. l{ r, l2Lv_ dT
permls are non-transferable and expire If work is
not started within 180 days of issnance or if work is
Suspended for 180 days.
Electrical Contractor
Address
City
Expiration Date
Expiratio 15;;;;;'
Signature of Supervising Electrician
OWNER INST ALLA nON
The installation is being made on r' _,.._.:" I own which
is not intended for sale, lease or rent.
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Inspection Request: 726-3769
't..D
ServIce Inclnded
\000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. I Branch Circuits
New Alteration or Extension Per Panel
One Circuit I
$\06.00
$19.00
$50.00
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
$ 50.00
$ 69.00
$100.00
$ 43.00
Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges
4.1 SUBTOTALOFABOVE <;z..
7% State Surcharge 36<1
10% Administrative Fee 5:s=-
60~
TOTAL
Shared Drive(T:)IBuilding FormslElectriclll Pennit Application I-03.doc