HomeMy WebLinkAboutPermit Electrical 2004-4-1
rl
, ,,' '''''''i"' t - , 1 1=.' · . sPA'NaF1ELD'~~]
225 ril in STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 -r1f~liiAal*$~liAA.ubml'b~~~
ELECTRICAL PERMIT APPliCATION:!~ zODlng. and,does not require ~1IlO48Rd'~~~
L{ approval.
City Job Number CovYl ZO CH - OOf L{ ( Date I 0 L{ 'z I . .....17
. ' ~ng ~~
, I I ' ,
i1""'..-.,....--."" ''''''''''''''''''''''''''''''''''''''"''-""''~1.t1:t?'/;l 3 W',t.9.~iETf~"'seh""""''''=I'''''''' ~,""'~i ,~l~.,;tor.~," ~l~
1. Q}[:J2J?~..r!9Et:,!2,f);,.lli~O-r~~ng~"f\!':;fj~ . "\., ~d~;;t~~";~,~~~-,~~'''~>' ;...,~g1Sf~~:~
1./0) 0 s. eeJw c o~ ' Authorized Signature '
LEGAL DESCRIPTION A. ~~f,;~r;f.,;'sili~~~'i1l1~~fhlhY,'Iffiftl"(v~ii~'t~ft~J~~
[>}i~~:;':;';"~~:'-:4a1."'~~~':w=,.~.~,";.)i""'~'~.1o.U':\'.O-, .. .,....~
(802. cbtl /0 '500
Installation, Alteration R~R~~~Won
e~\l\ \}\\\\',
200 Amps of(l~~ I 01e90(\ e\ loll $ 50.00
\t9\l\~p\~~499~&~es aJe ~5~.C}Q $ 69.00
p.."'0E.~"I<; 4~1~\fi~ tOiqQO'A'nl~,.Op..~ 1~\AS 1 $100.00
E 11 D t ".~ ., rl /. .., llllecll,tel. \'\loll~' I \ne e
xpira 'on a e n ./ - / _ r / ~ \.-"10.... . &~~.~r 1 OO~lls ~~w<la'bove.
\o\I{\C~ "c -J~tii"1 El ) '\\""~j~~\.09;;,-:. '. '~';. """ -.'1. "-".~
Signature of Supervising Electrician ~ t'\'O ~ . . ..!cu: i ..~, l'l"~C.)"<' ,"'t>'..,~: -",,'... .. I t~
( , ~ (\0Jl.: \ ~el. Ne\11 ~ -
~j~"C//)~~ ~ \OQ9~~~~~~~~I:d~~.,,~tqrt\P Panel $43.00
C. :.j'h (\1l~IIDl~li Additional Circuit or with .
D , 1 \ Service or Feeder Permit ' $ 3.00
Owners Name ~vVC-e- \i-';e,-""Q.j~
Address s37<> ~o-,..... h'..\\$ E. ~~~~~':~~~(~~~~~f~~~ill~~j.':~jg~:ili~i~1I5tf~~J
City W.s.Q. ~ Phone 6'8 E,-') 7' S" 8 ),ump or irri~X:t8f-~\?t. \lo ~~ \s ~Q\ $ 50.00
~t\\\C~lffl{{~tI.l.fin~~~i1t~f:> ~t.~t.'i) loG? $ 50.00
,1-\\'2> ~t~l:'8~llR~~J.\"l~ $25.00
The instalIation is being made on property I own which \\.\ 'i1;\0r..~it'i\!I}:~~6~mercial $ 45.00
,.~f\\i!I't:.\"V_ .'1 1i\:.'V\
is not intended for sale,lease or rent. Minlm~Elec'tric Permit Inspection Fee is $45.00 + Surcharges
f\.~1~~''''''~'.ltt:..","~''''''''~'Ii'1.1' ',,- \.i...." t~R"'~, ~:' '" ~ ,^ .....'" L(
4'1"SUBTOTA:J}OF!ABOVE~1" j;" .-,'>: ,/, ;'/ I L(
,"l;.oj"-}'''2'{.:: -_f4~:'"~'~'~~I"'-" "r,'t ,f I c,~~ ..: ~ .
/OOlJ
\ '1 L{
/(S~
JOB DESCRIPTION
<;: IC(L
Permits are non-transferable and expire if work is
not started within 180 days of issuance 'or if work is
Suspended for 180 days.
f~NTIDiW'oWrNsTIi'riWiioN~ONiY'
2. , .~\"'\".1';:'!fJl:"."'" l""tI-~..~~;~'q;;~':1>""~~~.~"""~
Electrical Contractor 17Io.RJ. J7?J."-- J ElK") f(J:::.
Address tf? () ,-5t'ir' (}vL/ <J
City a"r
Phone 9)'-<) -e;o,,!i.7
Supervisor License Number 50/7 g
. ExpirationDate /0--- 1- 0(0
Constr. Contr. Number / //(7 :<;,72 7
OWNER INSTALLATION
Owners Signature:
bispection Request: 726-3769
Service Included
, 1000 sq. ft. or less
Each additional 500 sq. ft. or
, portion thereof
1
z
$106.00
lOb
38'"
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder '
$50,00
B. l;S~~'"f,~~,ces~6F~';iiir~~'f~ililio~liW~tio'~s~,"~f;'Reiot:ti~im~~~~
~~_,,,,,,,,""""'.~~~~BJ;.P"~..v&:'-"~''''''''''~'OJ''''''''''.,!;.~-'l'''.'''''''';..~",":".;J
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsIVolts
Reconnect Only
$ 63,00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c. ~it~lt~n:!$.;mff~~~oJLF~~~gj;- ~;,1' -;~P.'., >:~~~~::ft~~ .:'~::~~\l
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:YBuilding FonnslElectrical pennit Appliclltion 1~3.doc