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
$100,00
Over 600 Amps or 1000 Volts see "B" above,
D. rmm'l'li\G<nre9on 'a;, r~-;"lIir;,::,~-u~to- -, - -- -- ,
L'fotfbWrOles adno ad bv .""-";,,,:""1- " -- --- -----
JljewtAlteratirn.or Rit"11sion 'Per llanelJn Utility
o~;'ci:c~'it~' ,-,,,neeI', I nose rules are set$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