HomeMy WebLinkAboutPermit Electrical 2003-6-20
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F :~~fq/mipr6'3689" .. "-;1ed has thet " .
l}6M"\g....a~a 0"""". I 0 OWIng
ELECTRICAL PERMIT APPLICATION approval' '0,,, ,-", speCific land use
City Job Number CoW1'ZOO'3 - oc,'../O 7 Date 5/Z 3.k, 3. Zonlr'p -___ LDtf-
I. LOCATION OF INSTALLATION 3.' C~;LETE:ti~ (?,CHEDULEBHOW....fb ~ 3
J~80 w. Q<.A.(""AIt- ,0lZeOb,,,,.o,..,,_
LEGAL DESCR[PT[ON
1703.2-75 Z.
001/];
JOB DESCRIPTION
~\.~
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
Electrica[ Contractor
Address
City
Phone
Supervisor License Number .A
Je'-
,j~
Expiration Date ::/
Consfr. Contr. Number
Expiration Date
Signature of Supervising Electrician
OwnersNamelt-CW\A-S I~~t~~
w. Q......, ~,4-l +-
Phone 7'f( - 77,7)
Address
/580
S.p~
City
OWNER INST ALLA nON
The installation is being made on property [ owo which
is not intended for sale, lease or rent.
Owners lture:
~~ ~Llq'6.
/
/1
Inspection Request: 726-37 9
A. New Residential - Single Of I\1ulti-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq, ft. or
portion thereof
Each Manufact'd Home or
Modu[ar Dwelliog Service or
Feeder
$[06.00
$ [9.00
$50.00
B. Services or Feeders - Installation, Alte~a,t!c;-ns or Relocation:
" ~ :ur-,;:urutT .+~~~- . .~
,,[JII Utili V
- ~$ 63.00
'--""'_11-11.'
, ,$.15.00
"'. '"-,'
, , $l25.?0
n' .,>~$[63.00
. . . $375:00
, . " $ 50,00
?imb,mpsorilessll:!'"
\'20 [,Amps.to 1100J\mps
',40 LAmpS'i6 600'A:~ps
l60'iA~ps' i.0l 060' Amps
I"...... ...'., 'r'
Over [000 AmRslVolts
Reccmnect'0ni"y' .
C2nt:
, ,
-."!
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 [ Amps to 400 Amps
40 [ Amps to 600 Amps
$ 50.00
$ 69.00
$[00.00
Over 600 Amps or [000 Volts see "B" above.
D~ Branch Circuits
New Alteration or Extension Per Panel
q~1.!;If'l.il r. '," l.1W$)liii<Oo
IllI<\8, WdddWl""i!~qi,~Uit brr~lh'~ 'RwiI-:" ISfn
Si\ti-\Ite \Sr-FeeDer Pennit \\S Pr. ~ ' 0
1\\j:;~C,\I~l'\ \ .', dI\NDONt.\HY
E. Miscellaneous (Servic'etreeder not included) ':'Each Installation
U\ .' \ t'crlIUU. ,
t\.\ IlJJ l.t"\
Pump...~r irrigation
SignlOutiine Lighting
Limited Energy/Residential
Limited Energy/Commercia[
L/3
/2
$ 50.00
$ 50.00
$ 25,00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
:5~
P>.&:5
~.~
\0'\ .3~
')
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drivt..'(T:)lBuilding Fomls/Elcctrical Permit Application I.03.doc