HomeMy WebLinkAboutPermit Electrical 2006-3-20
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-36l11kllng ~~c ~evnj
ELECTRICAL PERMIT APPLICATION Data j- " ~ "'-
City Job Number r.() W\ roo S- - 00 17 g I Dat~._", ,,~.t.z.fcd;>
I. LOCATIONOFINSTALLATION 3. . COMPLErEFEESCHEDULEBELOW
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LEGAL DESCRIPTION A. . New Residential- Single or Multi-Family per dwelliug unit.
~ 170 s2 Z 2..D 02.(;6"\ Service Included
r. I I \ '
- CITY OF ~:,,/RINGFIELD, O~EGON ,,/ :.
. ,
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
Signalure ofSllpervising Electrician D. Branch Circuits
// A./7 NeWAlteratiOnorrr,~~~el
/ 4/.// L - W;)1\C~: One.5AA~t. EY-I'IR ~~t-/I\i \~ \-\~, $43.00
- ~ <:; ""t-A-n,F ?,ML'^^- i~IS !O\:~~';~~~~~Q~~~Q\\ $ 3.00
Owners Name , 'I:: .,. t.\\ln C\:O 0\\ IS~tl
Address a. <.or 5M- +e- ~ ? / A ~N\N\~ \)~1{s~~S (Service/feeder not included) -Each Installation
..-./ yI f..1~'{ '\ 8\l
Cii)t.!fOO.......,;..J- Phone Pump or irrigation $ 50.00
'307 - 7bG - I..{II(, Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited EnergylResidential $ 25.00
I '1/. ^,,-
Limited Energy/Commercial $ 45.00 ..,:> .....-
~
JOB DESCRIPTION
IJoi lA- d-IX~ ?&.f"lih~
Pennits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
. CONTRACIOR INSTALLATION ONLY
2.
Electrical Contraclor ~td! I-dlcr.,,'1! ~CJ
Address ..:; 01>D ~ e (4 B Jl.. (+lJoiL.
City PDI'H~
Phone S";>?"-ZPS-f7l.P
Supervisor License Nwnber C;,,?, L.€:!:5
Expimtion Date /6 - / - 0 R
Constr. Contr. Number (., 3 b '11
Expiration Date
1..-/5'-07
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$19.00
$50.00
B. Services or Feeders -lnstallatin"1!;1\llerations or Reloclltion:
. \ W reC\U\t"~ - -\i\V .
,,,,,I' Oregon a egon Uti 1 .
^:Ti~O"Amps'or lessdd by the Or _ 00' torts 63.00
,.... InC "OOUl ules a, - - ..
10\\C40t~~~~~'h'l9~ t\'11Ps:e r h Of.':'. ~C;?-00~-75.00
"o\il:\.OIl"'mps to ~OO {'<.!I'Ps oug . \'_ = ",Ip.S \$)25.00
I' _ cc;?_001-UU 'es o. ,.-
in 0.601-Amps to IOQQiAmjiSl\l1 t_'onhOne$163.00
vO'bN3,,/ u ".' te' t\1e -. .
oogOver-l ~'!, 1'IJP,~91~'0 '.. t 'n.;fica\\0~375.00
cl&~Co1!n\!ctOhl~ Oregon Utility 3;~) $ 50.00
number lor tn<J is 1_800-332-2 1 .
C. ~ T~!!Ip(G~rse~i~es or !~e_d~rs
Installation, Alteration or Relocation
$ 50.00
$ 69.00
$100.00
Minimum Electric Pennit Inspection Fee is $45.00 + Surcharges
4. , SUBTOTAL OF ABOVE
8% Stale Surcharge
10% Administrative Fee
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5"3 e
TOTAL
Shared Drive(T:)lBuilding FormslElectrical Pennit Application 1..Q6,doc