HomeMy WebLinkAboutPermit Electrical 2003-7-28
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.3753 . F~J~~IJX26.3689 .
. 109 protect es submitted has the'followlng
ELECTRICAL PERMIT APPLICATION zoning. and does not require specific land use
. /' / / approval.
ClIyJobNumber COI41Z003-0C> t;:>f7 Date 71Z5jo1' . '''' /)
I / ZOning 1_lJr <-
,I 3. l C(jMPLET~1;1Ef!t$€HE.Pl.4111>J.'.(CIWI.:At{.-o~.~
Authorized Signature "'ff/..tJ
1. I LOCATION,OF 1N8'l.'ALt.AiipN:
'I L/ 9 ?n./::-sc...d LAI
LEGAL DESCRIPTION
'7033. '-III
JOB DESCRIPTION
066/ b
;4-bt.. Z
. c.. I /Z.<..A;- f....
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. I CqNTRAC'I'()RiNstALLATJON O.{VLY'I
Electrical Contractor JZohS t::/~,-h",~
Address 2 I > S" 0/1' '0 J-I-,
City (;"'1 <!.J,..(. Phone b f t- J,/ '-/ If
If / tflf S'
Expiration Date / () - D / - 0 'I
ConstI', COntI'. Number ~- 1'1 b / LlCJ
tj1-2.)'- 6'/
Supervisor License Number
Expiralion Date
Signature of Supervising Electrician
PP< ~ ::z:::::...-
Owners Name J.... d f 0 f f-
Address 9'19 ?rt::>;co fI 1.#
City
'5f',....-""
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature,
Inspection Request: 726-3769
A, j' jS"" Res!d.ential- Single or J"1'!.Iti-Famil)' per' dwellihg ,/nit:' .,
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
. B:i'sehic~s o~,Feede..s - rn~talla'tioll~' Alt';rati~ll~ o.~Relocalion:
200 Amp~ or less $ 63,00
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps ",.\'.0\$125.00
601 Amps to 1000 Amps ~~0~ '1~'U-;s.\~~3.00
Over 1000 AmpsNolts ~ ~0o.<S ~p.Q,0'~ q,llj"'~$f:i5.00
RecoIll1ect Only ~ \0' ~0 0 a~: 0.<:1 ~<J9\JO
0.0,0, ...,,\\1 _ t,s,G r'\~,. f> ~~ _,,0
C. FT';mp6ra'~~k.ie€~~fl!,~~"!'; ~',.:;.p'~:';S>.~ .
S\ \- ~'" 0~' 0'11>" ,,\"'- 0...a >>"-
,.d(:,'" 1;.0~ ~ 0"\ ~PY - ~ ~O .
1~i;1II::gqU, ~feraA(6n 'k~~ek\'C'~o~~ ~~.
20Q,~~'tn-OO~~ 0'0 ~0~'~ O~ \j~f):"{; $ 50.00
20~~~ ~'ll>~~~~0(\ O~0~O"r $ 69.00
401 ii.,'!9-6P~~P$\('0 \~, $100.00
.CI 1:? ~\\ \0' ~\0\
Over ouO An'lJj.'k~iQ9liW()lts see "B" above.
D. I 'Branch tJ}'tuits
..
New Alteration or Extension Per Panel
One Circuit I $ 43,00
Eaoh A<lditional Circuil or with ~~'?-:.'f..
Service or Feeder Permit ~;.. ~~qo
_ ,<;."\ ~ ,c,
E. li\tisc'lIalle~llS:(S'n:i~'!\.<ille'r:'iWt5i~IR~}'\.Each IlIstallationl
. ~tr-\..\.- ,\'0''' ~S",..;
Pump' ~~~t\W'\ S ~\::r..8' 'X>tr-~<;j $ 50,00
Si~~tli~,Et;W@g\J ()~ ,'0 ~\) $ 50.00
Limid';d"\?n~<;~ntial~'() , $ 25.00
~"'b':;',,,,,, ::\' ~
Limiled Ene~/r^,l;'.wrcial $ 45.00
\.)V' ,'(is'--
Minimum Electii~ermit Inspection Fee is $45.00 + Surcharges
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1f3
'3
4, r SUBTOTAL OF ABOVE '
Vb
) '2"Z.
!.j(,1?
-SSKZ
7% State Surcharge
10% Administralive Fee
TOTAL
Shared Drive(T:)lBuilding FonnsIElectrical Permit Application 1-03.doc