HomeMy WebLinkAboutPermit Electrical 2004-9-27
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAYfJiRMIT APPliCATION .
City Job Number (;(JrY) ;;? tJl) Lj - 0 / ~ (]7) Date ~/:?~ ) J 0 ti
____ --- _ _ ---- -- --- --. 1"___ --.-.- -- - L --'---. - - --
I. LOCATION OF INSTALLATION :: 3. COMPLETE'FEE SCHEDrJLE Bt:'tOW
';/:";-2-2~:; /iiJi::;',j)~ ---_~-----~- -_--~---~, ---~~-- . --:-.---.
/ ?t ~scD~o/..J- 0 Lf l>/0 A. ;~~:::~:::~~I~~i~gIe~Or~I~!ti:~~mi~ p~ ~w~lin_~unit._
JOB DESCRIPTIOI)I ( 1000 sq. ft. orless $106.00
C) ~ (. I fL Each additional 500 sq. ft. or
.d \::A~" ~ . portion thereof $19.00
,.-H 1....,...1.....-, -.. ~, '~V"'.d ...'lLllreS ~IOll to
. Permits are non-tr.nsf~Di~lelal)dle;xpite'lfLwo(k;is:l'~ urey()r.E~<;hit>;lanufact'd Home or
,to not started within 18Or!l.'!~f,I!!i!~~!\l\!!~~\C!!I!f",,'!!:I.s'!srui8S are M~~~!~fPwelling Service or
Suspended for 180 daYrI'OAR 952-001-0010 through OAR 9SCZ-cteS1-
! CONTRACTOGPj.fi::.f!4Y}fijito"f.r'lJ "~~ 01 th'8!QISi..Ql~es or Fe~ders'-I~;t;lIati~~,~lterations -o;-Relocalion;:
:lec~ca1Contracto~ W;^~~~~r, ;~ et~~~~;'PSOrleSS ---------~$6~.~~--u- ----
\.t., ,"'-'" ,- ). 201 Amps to 400 Amps $ 75.00
Address 9'7() (~:JJ 401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Phone 1/f?<:;""-~.659 OverlooOAmpsNolts $375.00
, Reconnect Only $ 50.00
City 7-1"~~
7 (;/
Supervisor License Number 1 SA I') S
- v
Expiration Date ? I) / 11 _~
Constr. Contr. Number -:,- <2 6 0 D
SPAINOFIELD -_:=:..........-, ,
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I -~" ~j~<"'J
"-----.......
$50.00
C. t.. Tenipon.ry Services or Feeders
- ......--- ---<--- .--'" -- --- .._- ---- - ~
~~._J
Over 600 Amps or 1000 Volts see "B" above.
D. rB;;'nch-Cir.;af~~li,J:;.0i:;- :I~l';'- .""- .-~ -----.
HO:l '(JiNftONX-:tlV""SJ:lTri-M'1 I~;-i<\'i;:';;---- --- -- ----
10N 81 NewtiAIteratlOn8rIExtenslOn~per\panel
.w, ~a '.'>IHi o3UNII U3ZllJOfUn!1
'ilJOM 3~!l{I*A~~~1 tlMg~ol ~i~3d SIH'\
Service or Feeder Permit .3"1' n ^.
u __."
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
Expiration Date
$ 50.00
$ 69.00
$100.00
$ 43.00
I-f.:;s . 0'0
. ,
s.ot:)
$ 3.00
r-~ - ," ----.----.-.--:-.~- ------',
E. 1.:.~scelIa!leousJService/~ed~r~ot in,:~dedL::E.,:~II1~t~lI~tioll i
OWNER INSTALLATION
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
The installation is being made on property I own which
is not intended for sale, lease or rent.
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
4. ' SUBTOTAL OF ABOVE
, '..
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:YBuilding Forms/Electrical Permit Application I-OJ.doc
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