HomeMy WebLinkAboutPermit Electrical 2004-12-10
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SPRINGP1EILD ...
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (~~9 ~
ELECTRICAL PERMIT APPUGATION ' o~, i?<, "0- ~.o~g,," "
""'30 () '0 ->t," ~ ....~
City Job Number Co""'?o 0 '-< _ 00 -, 0 Date ~c ( r!'t{". 0"" ~ "0 'i?~ .
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_ .~/~;d.1.t1,2N:~~~;41.i~:6;~ ;il~ ~~9Ml'g1~~~' \<~~~~~~:
LEGAL DESCRIPTION /703 Z'-(<.{3 OS'-to-o A. ~~~,!i~!I~~tfrt"':~i~gt';'O~~~~':~,unit.
II" 4- f 1)(011 fl /} ~ c t 1"1 fi-/ Service Included """,'J:J:~ .~.. '19
JOB DESCRIPTION 1000 sq, ft. or less ~ ~I~O
Each additional 500 sq, ft, or ""- '
A !:::l/\' c.. \ (l.C<A.", 1- portion thereof ~ 19,00
-~ --- - -- ---.
B. 'Se~j~ei~:l)tF:~f.r.~'!''Tn's/,lIll.'tiWi~r.r~li~4s~o~'\i~lo~atio~: ,-
~.--~. ,:..It';f..!:.::' ':~'l~/~'.'g~t\i"iti~/J~.t':--t:ft'1 . ,",.,
/ 200~rl\\>~df\~'lAY PERIOD, $63,00
201 Amps to 400 Amps $ 75,00
401 Amps to 600 Amps $125,00
/ 601 Amps to 1000 Amps $163,00
City Phone Over 1000 AmpsIVolts $375,00
Supervisor License Number / c. R:::t;;YserV!~es' QiEeeiie";'" , . $ 50,00
Expiration Date / ATTENTION' OrAnnn law Installation, Alteration or Relocation
, ' - reqUlreU:!2!l ta
, fO~IOW ~'es adopted by the OtJl8orl"aii9(\ess $ 50,00
Constr, Contr, ~mber Notification Center. Thn~e rUle1~1t'!!'J'fM'il00 Amps $ 69,00
,,/ ~ UAH 952-001-0010 through d~A~~6'D~?o Amps $100,00
EXp,;Ztlon ate :~i' You mav nht,,;n "'opies OfOy.~ ~()""mp,s 01'1,000 Volts see "B" above,
S' fS" EI aln9 the center. (Note' tl'D tb.lira'na..iojrcuils.' .':. -, '
Igna 0 upervtSlllg e9lUffiI!Ier t th 0 "1l:.;::J -' "" , . . , .", "
or e regon Utility I\~tifi"'oli~'" ' , "
, Center is 1-800-332-23 eW J>Jteralion or Extension Per Panel
, !I e Circuit ' ( $ 43,00
Each Additional Circuit or with
Service or Feeder Permit
Permits are non-trllOsferable and expire If work Is
not started within 180 days ofissuance or If work is
Suspended for 180 days.
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2. ", ." '"" .. -- '," .. , ..,',.,...j
Electrical Contractor
Address
Owners Name (}l9v,dJ C. ?BS ~ V'
Address :J. 17/ 1?4~{ C~"'N.J. /
City 5;:71";"< .p,~1d Phone '1/S'- - J:;.5'1
. -.J
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
lJ:;e:fJ
"Jdh
Inspection Request: 726-3769
"
Each Manufact: d Home or
",'I'I'yrl" .
Modular IDWelling Service or
Feed~ilS rERMIT SHALL EX;'l~[ If -;-IIEWa~K
,: I
.,
..' 'I
V:J
$ 3,00
E. IM!Sce)iane9.~.,(S~ryi~e/fied~~ rio~ inc,luded) ,.E~chln~!;IlIati"n I
Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50,00
Limited EnergylResidential $ 25,00
Limited Energy/Commercial $ 45,00
Minimum Electric Permlt Inspection Fee Is@O + Surcharges
4. l:sli~;';'~ADOF,movi;;:,', : : I /J~
~,;;o"l'':'~f\.':k''''~'''~ .~-- . ". ~ "7
'3'F
'-fro
$'z,6.-C
7% State Surcharge
10% Administrative Fee
TOTAL
ShBrcd Drive(T:)lBuilding FormsfElcctricnl Permit Application 1.o3.doc