HomeMy WebLinkAboutPermit Electrical 2004-3-24
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION ~ j., / The.followingprojectassubmiuedhasthelollowlng
City Job Number COVl'l ~ - 00 z.. ') b Date l' Z 4 / cJ '-I ~~~,~g~a~nd does nol require specllic lend use
1. i ,iOCATToNOP,iNSTAiiATi(JN'.-~C.:c:..'i 3. :'C0f1;:4TEd:EESC,HE'iJ1!JU iJ;;Lliw ,- ~(L::,... '.:
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/hl Z (2A-W1 b ,:../ br._.. "Authorized Signature ~vJ
LEGAL DESCRIPTION A. .New;,~~si~'enlial..? Singh' or lVl~lti-F:,alri.i1)' per d,velIing",inil.' . ,. .
,,__ __ ~_.........__ i.. _. ......._ _.. \-L. ,,_ _,_ ..... ......,_ ._ __.. .'... ,._..... ,_.1. ',_
I 70 "S 2-'5' Z 2. C> ~ 2-0'0 Service Included
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:.5 C( /l...c...""t c:;.
1000 sq. ft. or less
Each additional 500 sq, ft, or
POrtiOD thereof
$106.00
JOB DESCRIPTION
$ 19,00
Permits are Don.traDsferable and expire if work is Each Manufact'd Home or
Dot started within 180 days of issuaDce or if work is Modular Dwelling Service or
SuspeDded for 180 days. Feeder
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:,,,:::=~7:'E~~L~ In: ,~:::,~;:",,~C~"'."i~",A'"p!::: !,,'~,,;''''
201 Amps to 400 Amps $ 75,00
Address 1.{;Z~.I/o.J,f "'filA-- b T 401 Amps to 600 Amps $125,00
"1"" lIe-- 601 Amps to 1000 ,~mps $163.00
City.f.:~ Phone jjlf6t"-'i?7Lf'J Over 1000 AmpsNolts $375.00
I Reconnect Only $ 50,00
Supervisor License Number '-1734 -.s c. r.reni;oraty S;r~;ic;'-o~F;ciie;:-s --~. ---,.---- : -, ------1
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Constr, Contr. Number ZO -tJC, 3 c.-
10 -rfl-/
$50,00
Address
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sPFO
STe-V& 1t::7'1 n:A~F'::
I2A-Wl/SLI tV (r ~ It
Phone 72 E, - 'b7 70
IDstallation, Alteration or Relocation
200 Am~9,~TION:Oregon law re~u~~8J6>.U, ~o
201 Am~II.cD4f)QtAiiiPSldOPted oy 111" vr~%WMJt~~,
401 AnlPJtili!6l)liOOn~~mter. Thos" ,ulo"'Jlf..~ll~tL~:
nAR Q5~)'()01-Q_010 t.uvu\jl. :>;l\~'tlS'2..{)-
~_~e,::,600~~PY~ilJWgy8\)\a~n'Cb~'Ottbe [U!o9 t ___
D. ..:.~ra1;l~~'lifxrJ\he.Center. tNo~f}; !h~\~~pho~!3< _.-..J
New AIt'llllmbll>rll!l.flllilil.QmQQ.Ylllity NotificatIOn
O C. 't ~-_.~.:~ 1_Ann-~~?12<l44'.00
ne If CUI .. .r '"'$'43.
Each AdditioDal Circuit or with z..
Service or Feeder Pennit $ 3.00
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Expiration Dale
Expiration Date
SigDarure ofO:Llec~d
J '
Owners Name
,,-r.-"'-'--'~ --~- .. - -- --~ -. . -
E. :J.mscellaDeous (Se~vice/feeder not inCluded) -Each Instalh;tion '
. -,. ,,-'c- ::..:..::.....:......____.--.:..-. ____:..._.. .. ,;"..___ .. _._..J_ .,. .....:.-_'......i_._...l
Pump or irrigation $ 50,00
l
.. .. Sign/Outline Lighting $ 50.00
.-.'
OWNER INSTALLATION Limited EnergylResideDtial $ 25.00
The iDstallatioD is being made on property I own whig~OTICE: Limited Enere~Cffinrw1~E WCf'lK $ 45,00
is not iDtended for sale, lease or reDt. THIS Rt'fJjM~TnJ&~t~c~~~~iWm;'1'if& /-ltJJls $45.00 + Surcharges
OWDers Signarure: ~~~tI~~z.t~i~~fliFlR7}wJErOR' . -.--, 4 '7
ANY 1B(i"DAYPHUOO:'--- .-----.. .
7% State Surcharge '3'1 j
10% AdmiDistrative Fee it ~o
--.S 7 33
City
InspectioD Request: 726.3769
TOTAL
Shared Drive(T:)lBuilding Fanns/Electrical Pennit Applic::uion l.o3.doc