HomeMy WebLinkAboutPermit Electrical 2003-5-2
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':' '<' " '-, l'CITY OF s' lrNGFIELD- OREGON ~,
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225 FIFTH STREET. SPRINGFIELD, OR 97477. PH:(541)726-37S3 . FAX: (541)726-3689 bmitted has the following
The followmg prolect as su d
ELECTRICAL PERMIT APPLICATION 1/ / zoning, and does not require specific Ian use
.CityJObNumber C()/MZC03-0oZ7r Date 'f, ]%.3Pproval, , Lb(L ,
/ ZOning .;J,...eJ:)
1. I LOCA110N OF INSTALLAl'ION 3. I COMPLET~E !WHFnr rr li: llEEeW .5-~:" .
9/5 r~~/I./lI,--tt: Authorized sfgnalure .
2. I CONTRACTOR INSTALLATION ONLY I B. I Sen'ices or Feeders - Installation, Alter-atiolls or Relocation:
Electrical Contractor UHech&;., ~(;.,M(-:JJt<200 Amps oriess $ 63,00
201 Amps to 400 Amps $ 75,00
401 Amps to 600 Amps $125,00
601 Amps to 1000 Amps $163,00
Over 1000 AmpsNolts $375,00
Reconnect Only $ 50,00
200 Amps or less $ 50,00
201 Amps to 400 Amps $ 69,00
40 I Amps to 600 Amps $100,00
Expiration Date / 62/ 3 ~/ 0 ,] \)\~€0~~\)fi60~ps or 1000 Volts see "B" above,
Signature of Supervising Electrician \~'l'l ~0bP.<:j~I."ul'c'h:;:'~~CUits
01\ ~0 ."'.-. .;.;(.:-
-) AJ// _.,\.J,0g -''0'1'" ,\)\0'=NeW5\iteratir.;>or Extension Per Panel
ul~' 'l..ev e' (11'" ~\)'-
~ v . ~ \ \ ^nO~ -{.'(\O'i> O\)Q,'(\ One\Gircui!J~e I $ 43,00
~ ~\ \ v ~\)\e~"~'- ~\6'~...O~~ ~\e~~'ci>y.\'~~,~al~brcuit or with
'i) / . \0\\0'l'l _,...:JI~ ~~.<l,-, ~~ CO 'l..0.'Serv{<;.e3ilJ'\Feeder Permit I $ 3.00
OwnersName DIU! VtJ.1'I~~ :~'I. I~O .,.'S,\'! ,1\.'\.
/') ~U' ~':I- ~"" 'l..0"\: u'l. '1';)" I
Address %/ ~- I r /l tfll CvCT.:L-iO\) ..0 Ce~ ~0Q,O~~o<J.?l\liscellaneons (Servicelfeeder not included) -Each IlIstallation
, O<Jv". \~ \" ~r,f;'J ~O\)
City S! ;) L/r:! Phge f<~6,~\1'l{if Pump or irrigation - woFW,OO
v ~\)~,\- GIl" ~~liine Li~W\.l E~PIRE It ,n~ f ~r.OO
OWNER INST ALLA nON \-iW!l<1l\Bfi~~~~tlltil\lt\lS PER\'4\~ '-3l\$ 25,00
The installation is being made on property I own which I;ilYit\:\OOl ~ ffi\"lsr~Iilp..t100Nr.U ( . $ 45.00
is not intended for sale, lease or rent. MinimGliltEr.\!i~C enl'i!RIlS/iktion Fee is $45.00 + Surcharges
'If' 10.1\' .\ ,
4.1 SlYBi-OTAL OF ABOVE I lfh
'522-
I{(P
53 ~
LEGAL DESCRIPTION
170S 3l.(tL{
0'7 S"O'Z
JOB DESCRIPTION
/) I P /-hcrr.. (j (.f3L / /in r P U-~
Permits are non-transferable and expire if work.is
not started within 180 days of issuance or if work is
Snspcndcd for 180 days.
Address 0, (). ~ ;lW:?'J
City
fiuOAh
v
Phone 0rt t .2JL
.upervisor License Number 3 t..( '17.<;
161//o~
,
708'g-Cf
Expiration Date
Constr. Contr. Number
Owners Signature:
.
Inspection Request: 726-3769
A. I New Residcntial- Single or Multi-Famil)' per dwelling nnit.
Service Included
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
c. I Temporary Services or Fecders
Installation, AJte.ration or Relocation
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuildlng FonnsIElectrical Permit Application t ~3,doc