Loading...
HomeMy WebLinkAboutPermit Electrical 2004-2-27 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number CIHt~ -(()j..1/ Date (' _"_~'.........~. '-._,r.__._m. -- .,..-.-. 1. ,LOCATION OF INSTALLATION '4;j;-so;iJBw;b/J'" . , - LEGAL DESCRIPTION ~/)2-()IOI/ I~SOO JOB DESCRIPTION .. SP.tIt w/ ~ 6MLM6- Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ~ ....~-........- ~_.- --'- ~..,........ --..~._'- ---.- ~.- 2. CONTRACTOR INSTALLATION ONLY.; 1.....__ ___ .........-.:h.,.._ _ ._, _ ,'~_~_. . n_ ___ .__..._ Electrical Contractor L t;. E [Le ~ Address j1<SOP-f $DR-Vlu.r ti.cJ1y~ I Phone..lf~~ J.::, 'i ~ 933...~53 1ft 7Lf- 5 IO!I/OL(- Constr. Contr. Number I ()' 'S ''1 ('5 '1/3oloLf City ;:; JC\ Q (\ R. I Supervisor License Number Expiration Date Expiration Date r' Signature of Supervising Electrician ' - ~*" Co (\ /"'\ ~\S ~\ ~ } hvd Jtd 'h..'\x-~ ~ ~ - ,. ,~\\~~'\'V~' Owners Name i2.4.J......_~~ll~~( ?~;'\,~v Address C, 575 r ~y~~\'tj <c:. ~- ~v f.>' City ~vu~,'<>-.~'-~ -;,~\~~~ -9'1-.5/b ~\)~~.:.iv ~Ir:",x,~ ~'<; ",Sf. .~.~ ~ OWNER IN.,:r#L;\~lON\)" ,?-V *~ 'O\;) The installation is\,*i!!!i-~ade on propeny I own which is not intended for sa1~~lease or rent Owners Signature: Inspection Request: 726-3769 .;- ~. ) " '. - Service Included 1000 sq. ft or less Each addftional 500 sq. ft. or portion thereof ~ $106.00 2- $ 19.00 /IJ~ 82> Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 ""~r -;---.- --- . - ... ---- - , 1- ,,-' -'... B. : Services or Feeders,- Insialiation,'Alterations or Relocation: L __"- _ _ _ ._____,_.,. ... .' __ .... ,. . , 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only $ 63,00 $ 75.00 $125,00, $163.00 $375.00 $ 50.00 c. i T~mpor;.:y:Se;vi~-es or F~'-d~;s- ----- '---.......~._.. _. ..___ _ ____ ..._ __.._ .....0-.....-_ . . -- ... Installation, Alteration or Relocation 200 Amps or less J..-' 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above, r'--'-"--'- -.-- ., ,. -_..- -.--- ....~. - -. - - - D. ,Branch.ci~~uits - " .....- - _".._..._". -~-:"-...- .-......\ ._- ,0.. ~ New Alteration or Extension Per Panel) ff"" ~ r,.... ~ ,0 One Circuit ,0 " n"-S@\OO Each Additional Circuit or with &!' 0($/ ~0 "> <-,'1: (',<,' Service or Feeder Permit ",'li ('<: q,; ~ ?-is,'}OO,(Zi - tit' 0' 0"" ~ 0 0' ',0' "C'----. ----,,-OS'~O ~-&,J; - . E. l Mis~e.~~eou~(~e!'i;,~!l.tw~~;!.iJ(~~.f~3~h Installation: .0" ~'li ,,-'" ~ Q~ OS' "'" l);\' Pump or irrigati06~' ~O~~. <::> ~ r!=l _0' .:'{$\Wloo Sign/Outline Lj11Jitinl' n~0 <;.)<::>".~'" ,~u .,v-;~!56.00 _~"'i' ~0 G~ .,; 'S)' . O' ,,,' Limited Ellerny/Residential .\ 0 ,~. ~~ _\'to $ 25.00 ~ ~ 'fl' n''"' <:>'" 1-.' 0' go- Limited E'iierSY/gPmmerc{~1 (,0,. ,,' $ 45.00 '.0 .~ Q:. V) ,,~ ><:-0~' '.' Minimum Electri~PCI'\Dil-lns~tien F,ee is $45.00 + Surcharges " - - - . " ~V.9;r:::" ~<:'..b."~ 'rr , ..- , 4. ' S~TQTAL OF'Af1~,p: c --- .-..-~v'.. -- $ 50,00 $ 69.00 $100.00 '5':0 7% State Surcharge 10% Administrative Fee /tt1 ~ /~.~ _Ittt-ID 2.2-G, .'10 TOTAL Shared Drive(T:)/Building Forms/Electrical Permit Application 1-o3.doc