Loading...
HomeMy WebLinkAboutPermit Electrical 2006-9-8 SP-,FIELD ZON ~ ~~ INITIALS!'-ir-^-- - DATE q, -'i(-OCo -~ SOURCEI'f\~S~,...:S 0ftb COMPLETE FEE SCHEDULE BELOW ~:.~"'CIrY OF SPRl1\. )fEED; OREGON ~ ), . ~. ,? Of . ~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number ( OW" ~o <'c:. - 0 I \ b ( 1. LOCATION OF INSTALLATION: I)' g 12~~I'~1 LEGAL DESCRIPTION: 1703"2)'2 Z Date 3, o <7]"00 A, New Residential- Single or Multi-Family per dwelling unil, CONTRACTOR INSTALLATION ONLY B. Services or Feeders - Installation, Alterations or Relocation: 2, 'les'1ou 'u \_" -;? /. r./. _I. - ,,,VI te~UI " 0\\11\'1 Electrical Contractor <. ~OJ... /)~Y\C- v ..c;,.l,e~~n('200.Fmjisor less \0[\\'\ , P. '1'\\::1'1 ",:::; "-dop\ed b'!zO ;1~pSfg. 4"6d.Amps ,.;' ..-- II ~........p ~ 1\'\0"'" ~R 'l::>"'~' Address 1--,2.."> f/Ji un "o\\Ct) 1:._ r.8n\et. \\i40IjAmps to 600'Arrips' ,C<,",W' OO~O IV ~ \ \\'18 'u,v- \'lotI I ~ Q""'OO~' '" 601liAmSs to 1000-A:mps \:2;11;::/ ~~Mlll1Jo\al" v " . ,',c> \e\u\" " . Phone ..":.J::t:;:;:'i,(J\ '/.!1'D~' I \Over..IOOO AmpslYolts" uu~v;\ n9 \\'Ie -cenl~ 'e~ecbiiRe\jlr~JY ca, \'8t lor t\'le IS ~ ,BOO.332,2 ...~,' cf73C/X"'5 cenlel C. Temporary Services or Feeders (.hut~5 6Dvdon 'P..A Y\.A ~l; "1 " E. Miscellaneous (Serviee/feeder not included) -Each 1nstallalion ~. ~~~ I Phone,4lP ~~3.' pump\oLiriigalio\r ."" \'0 ~Cli $ 50.00 - - .' 'G. ,I\. c.'" on?,,,,,, ~Q' \\s t.~t-J\\\ ~SignlO~t1i~\\%.,glitiI).gD I'Ot\ $ 50.00 OWNER INST ALLA nON W:~ ~ OWlt.\) ~MRt ~~rgyfu~i;\aential $ 25.00 The installation is being made on property I own vt1\ic~ t-J\t.~c.t.~Li;;\h$-1~E.!>!'rgy/commercial $ 45.00 is not intended for sale, lease or rent ,c.~ '\ \l'ji\J.iili'u;;.ttleetric Permit Inspection Fee is $45.00 + Surcharges Owners Signature: 4. SUBTOTAL OF ABOVE L/ '7 " 8% State Surcharge :3 p Z. 10% Administrative Fee I( 'PO 5% Technology Fee ';c. 't } JOB DESCRIPTION: ' tlfftf- -;ft.{~P If!, I-lflY'J Permits are non.transfJable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. City ,~ Supervisor License Number Expiration Date /0 - 0'8 Constr. Contr. Number /S-fo 7(P{ Expiration Date 10,6? 'nature ~::llectrician ........ Own rs Name Address 1S:q Y City ~/J ~~ 0 ~- :2\ '"l.()bl Inspection Request: 726-3769 c Service Included 1000 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 20 I Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D, . Branch Circuits New Alteration or Extension Per Panel One Circuit { Each Additional Circuit or with ..., Service or Feeder Pennit & TOTAL $106.00 $ 19.00 $50.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 $ 50.00 $ 69.00 $100.00 $ 43.00 tI-?- ~- $ 3.00 Shared Drive(T:VBuilding Forms/Electrical Permit Application S-Q6.doc 60 z.2