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HomeMy WebLinkAboutPermit Electrical 2004-10-3 ~~~ing. and-does not 15 . I. Zoriiifg'!IN "'^ .Gi . . , il ("" ~ -e,\~' 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (54I)72~3l>'89 I .:-tY17/lii1C.JS:,/J~o. ELECTRICAL PERMIT APPLICATION h"U'Ume" ~Qnatu ~r ~ -.J City Job Number tnW12..0oc:..-n\":l:>4'i Date ID/~ IDS I ( , ..._-_.._.,.....,.~_. -:--~..,.-_.~'---'- - ~ --..-----..... 3. : COMPLETE FEE'SCHEDVLE BELOW _.______._ ~_. __ ________.___ .,_-'_ __ _" __'_on ___ cille 18no Ul;iU , ,:~~~::'" ' :,' CITY OF t"'""tlNGFIELD; OREGbN,.', ''f4: J, ' '\, -., ) " ... -' '. " '," \ . " ~ ~,' .... f , Permits are non-transferable and expire if work is Each Manufact'd Home or r not started within 180 days of issuance or if work is Modular Dwelling Service or Suspended for 180 days. Feeder 2. I CONTRACTOR INSfALUrto,N ONLy! B. t Services or Feed;;;s -,In~t~llali~~ Alteral;';;s~; R~I~cntion:- " Electrical contracto~ r/)'I1 (3- C \.u \'<I., ~ ~'\... ~~J~Rmr~-L~ ~PIR~ CI ~ $ 63,00 -~ 3.0'0 ~7 1/1 II AU~9Mlm~d~l!lPfHIS PERMli IS NO ~ 75,00 Address ql. , /~\.~t .~ COft9i\1~fV'Ct:rJtm~~BANDONE~H,jn _1$125,00 '\N~OfmPl!l1\lpjl;~OO'ps $163,00 Over 1000 AmpsIVolts $375,00 Reconnect Only $ 50,00 ,..-_'",;'_ _'~--:_. ----,....- .-- -'__e' _....-:"\;.~-. .....,.---r 1. ,LOCATIONOFINSTALLATION =- --- --'-f\.1--- - ,.c-.._ ' ___.J plo'-/ r-'L.~v\\ LEGAL DESCRIPTION I/03;;lS.3~ ~<03CJO R e:~ 1m.. '^ u.... JOB DESCRIPTION C t\1>,.V\,bl ~\ fr11,"I A>-4- , City sr'l Phone S/O.,q.:ss(P Supervisor License Number .<../~7'" S. Expiration Date / o} '7 I Constr, Contr, Number ct)O ~'S'~7C !t~d. ,q \ I Expiration Date / I-I q -() to S;;;;~ Electrician , I (-.~"'~ Owners Name '&LL S\e.\UM.~ Address No"f P4.~","\ City ~"'\l Phone71.f7- b~~~ OWNER INST ALLA nON The installation is being made on property I own which is not intended ror sale, lease or rent Owners Signature: Inspection Request: 726-3769 A. ',New Residential- Single or Multi-Family per dwelling unit. L.,......'"'--.____~___"~ ...._. __ ...:......_ _.. __"_ _._. __. .~_ . .___ .J Service Included 1000 sq, It or less Each additional 500 sq, ft, or portion thereof $106,00 $ 19,00 $50,00 C. l' Temporary Services or Feeders ~~-- -.- _._-_.~-- Installation, Alteralion or Relocation 200 Amps or less 201 Amps 10 400 Amps 40 I Amps to 600 Amps $ 50,00 $ 69,00 $100,00 Over 600 Amps or 1000 Volts see "B" above, D. rmm'l'li\G&ltnre9on 'a;, r~-;"lIir;,::,~-u~to- -, - -- -- , L'fotfbWrOles adno ad bv .""-";,,,:""1- " -- --- ----- JljewtAlteratirn.or Rit"11sion 'Per llanelJn Utility o~;'ci:c~'it~' ,-,,,neeI', I nose rules are set$f4~too -, '" ~o2-001-001 0 thr.I'ugl ~,' Each'Additional Circuil or willi ,UMn ::10.<,001- --,,~, 'Uq ",<Iv ')Ulp1n cop fth $ './lO Service or Feeder Pennit les 0 e njE , e-j' ".U<l~'~ Ull:I.cemer, (Note: Ih.e LI'lli'JlJ1anlL _ _~__., E. I MiscellaneJtis'(S~f..\ice/feJd~r:iioiinchidfd)'T-Ench Installation . ' ...... '.' ~..,-- '1'- .__~____ _. --' ".-. ..... , v....v....'..).c.-.c.::v~'.''fJ. Pump or irrigation Sign/Oulline Lighting Limiled EnergylResidential Limited Energy/Commercial $ 50,00 $ 50,00 $ 25,00 $ 45,00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges -- --' --- -- -c-;--------.--l 4. SUBTOTAL OF ABOVE ,., '" __,,-_____..._..__.._i 7% Stale Surcharge 10% Administrative Fee ,,~, 00 4,'-/-1 1/1 ,;).,(J ~.~ ,Ii TOTAL Shared Orive(T:)/Building FonnslElectriclll Permit Application }-03.doc