HomeMy WebLinkAboutPermit Electrical 2004-5-17
91'll1)Q,J/rojact as submittad has tha following
225 FIITH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: ( .~~8'!!6as nol raquira spacilic land usa
ELECTRICAL PERMIT APPliCATION approval. . L.b 12.
City Job Number CDI'S1'ZcOlf - 00 z8Y Date ZOning ./,
'-ll-oT
Date
3, ifroMP~F.EE/S~il,),jJ~;(*"OTM'-'.':~,' :~'lf:.'-":RuJ
~~,......o'n~."'''''''''''''''V1.''''~'~-'( .~ ~'..~_~~_ ~
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
n w- _ \^~ ,/' \__ '-1...... ServiceorFeederPennit
Owne1"SName'~'{'\J~ \e.C/V~vT LvS,TV.... 1TtJY....1(~
f'> IL 1+' \ E, W~elI1;'if.\':i~(S~~~7f~f%\\r~~I~,'dtd)'t::.Ei?ci1ti'nstillliiiii;J
r"'-rr 1 \ ~ Y"~">""'ft.:.,.-:"';"ii-~~''':n''., ;.,~'1' ''':..~'-:,:,-.-<- ",:'", '/~..i.J'l'.,~,"'':''''''',..",,- _."._.".....,,'_'~
Phone (,~h-9'1{'~ ,~i~r.ni.JPli=resyouto $50,00
Arll:I~TION. re n a r: . $ 50.00
Ide ,,' n Utility
OWNER INST ALLA TION follow ru es a 1. it..d av/JlRoUl........ f rth $ 25 00
Notification CerrrllP.m W''''''=~'''''' 0 .
The installation is being made on y.-y-..J I oWllr~ 952-001teRJite<\~Jblnalil8lO01- $ 45.00
is not intended for sale, lease or rent 0090. YOuM1ii\bfu~mt!ElIl,Rh\Pi'-;~ll~l~X Fee is $45.00 + Surcharges
Owners Signature: calling the ~""~~lfF~~;: 'g-;.::::;.1' ';'l.'\'I / L{ I(
numbe~~~~J8~~~~~j:1:T"'_~",:~,,- ",Jb~~ '4
7% State Surcharge ' /0 0 ~
10% Administrative Fee II{ '10
16~'fli
I. ~.ipCA.tjoMoF@STXlit:~WON':~i%l,l
." r.-::;_ ',:";: .....~....,",...."..,-, ........'.'....!.L'.>;......<- ....'.~..-n., !'
Ljo~o S Q.e..\,Nl'll"~
LEGAL DESCRIPTION
I <to LObll IOZ-OO
JOB DESCRIPTION
SF(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.
Iite;;;;:-;~CXOR'" -8T~'FUjN;'~fiA
2. tE':"-P~..l;lWti!I'Jli"~"-" ...~/!!f~Jra~~~~......t.-.."V"<'. --w. -,- .
Elec~c~IContraclorLr;'c EIJrjrlc' ,
Address f)~5.<, JCJIU5 Acre.:. eel
City '5' p ~I d
Phone tJ3J -JS'16
Expiration Date
'i/7Lf-5
10-1:91 ~()Jt(Ob
?
I cS4'L5'
3 - 3 L) -Jirl-ofo
Supervisor License Number
Conslr, Conlr. Number
Expiration Date
Signature of Supervising Electrician
r{] {A(1J~
Address 5'3. '7 ~-
City E v'jPYIf
Inspection Request: 726-3769
A. f~t~fR~; j~la1iitnU~Sin~ i.~r-6;:';Niiilti1F~Diij~(':?;i!eH ~~'inil ~Jni~' ;~::,
"t,.p oii.:]-'''~'''<;''''''~;oL",o(.I"...""gQl''''''''"'':'''''''''''~'''''''~''p....y....,~. ,'. ,- g..-. -._~ '1
Service Included
1000 sq, It or less
Each additional 500 sq, It or
portion thereof
Each Manurnct'd Home or
Modular Dwelling Service or
Feeder
$106.00
lOb
--:;,,f
I
z.
$ 19.00
$50.00
B. '~s~i~l~hF~~~~~'tt1l1i.ti~~i.iftr:ris'~R~',i~et;;A~ft~,,'lwJ:~
~ ....::.0 -, .r.; '1t.,:, ~'(;~~r1,"c.,,~""'Q';' ...; c~.....,1:"l",.,.,-" "):r'f'\j'll;'>."'"ll' ~~8
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/V oils
Reconnect Only
$ 63,00
$ 75,00
$125.00
$163.00
$375,00
$ 50.00
C ~-.~.t""r'-,~~, .,~ ..t'j~~-h~.. ~ '..)'\-r.r~;;"<:":';~..r4'~",'L.' '~~"'. '''1'', ;f"i. ~" r 0-'>'!r"';'i!~'1
. .. ,em ora. _....::J <, ces~or.;r,e~erirr ~, "o'''~::r ~ ~,.-.,;~, '. I.f._
....., ". p ~....r-Y."'"""_ c....,_.~_. o.:::'_~".' ,.',J (,,0 .... _~N~,S1~.,.. ,_"r,. ",.~f.J"..~1: 'i"."~
Installation, Alteration or Relocation
~~~~o~lJ;ss I ~ EXPIRE \~ n-l~ W()$~SO,OO
1H!~SI~~OO~et\ 1HIS PEO~^IT 1~_1'$)i9,OO
~l/JrMJp$\i'd:60blmlp's ABANDO"cn ~n" $100.00
p .. . , \ ~f\ OR IS ..---
O~~OO~S'.QT,lP'QQ j\(olls see "B" above., .
D ~-'''''''''*'i.!'j!:~.~'''I''-,''''~'~,'' h,' ;'45"''''',''-',' 5j;~:;""""<l"'<' =,~
. ranl!fl".C'lJ7cmJL~..;a;I' ~ .....'.~" t'. ., """,{' "~ ~;':~'t<J~'.I~~ '"..~-:;...(ir
....'....-'l..;...................ao;..., ..t~._:b\_ "'~.;'''''''''.',"~ ,t..:'f-...;v':J'=-~......1 .,_",.... :',r
$ 43.00
$ 3.00
TOTAL
Shared Drive(T:)/Building FormslElectrical Pennit APJ)lication 1-03.doc