HomeMy WebLinkAboutPermit Electrical 2006-6-28
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
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City Job Number
~ 1. LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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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.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor L. U. Me ('1' ; .. E.l-ec.4-.'rl~
Address '-\S'~ Shell.0.4 S-+V'f"o.&,.~
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City S r (l ""- ~ (\ -.l.J. Phone; L.(., - 0 ~ II
Supervisor License Number ~ 00 to S
Expiration Date loll / 0"
Constr. Contr. Number \ ~ ~ g
Expiration Date t-I"i I ~i
Signature of Supervising Electrician
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Owners Name 'P 4q,e IlL U __ \ +- "-
Address \ "2. ~ S \J. ~ l.... .::....-..:l .s 1-r,"c.+
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City E c...o..6 e H....a.... Phone
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
9,wners Signature:
',!IOTI['..C.
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n1J~ PEn~ ".' --
- I Il'iI; ~h;JlL EXP
~~n-IO_R;ZED UNDER y' " IR~ IF THE WOFIK
~IR~~Aq,!i&~C1{tN~~: IfP~-,tJ~ PERMIT IS NOT
. 1 ,..r: :1. / p -. f\fjANOONEO FOR
. u~" ERIOO
/p - ;/6- (J t.
Date
3. COMPLETE FEE SCHEDULE BELOW
A. New Residential- Single or Multi-Family per dwelling unit.
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. Services or Feeders - Installation, Alterations or Relocation:
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN oIts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limife1l1ij!\t.rlr~i5ntial $ 25.00
LinfltOOBn!:rgW,~omJ~~@n law re4lL;rA~ Sl.dti-oo '-l D ~ 0
Minim~~,;iierl~ieINr;'~t~~~~~~nt~e9s!i~l:Jfffi;bargeS
In, . '. '':: ~ 'C.U 1#}n i..t'-U.ln u e rules are set forth
4. SUBTOT;\LOF tJV.li,rough OAR
.. .~. i'<'n!-',' 952-0..0.1 L{DS' t:J"
c.. ,'0- ,elf I cO;:es of +h - .
.. . ,'rrH'~.,,' , e HIlos b '2.
8% StateSurchar~~ ':_~I. (;\ :]ie: L'~e tel:=-nh" y 0)2." L{CJ
100/ Adm' .' l"'F ''''''r'~ , '."', -,~ ,one 41\
/0 Imstratlve ee':.c""u.:,I;'.I",I_.'., . "',~
. '.r IS 1.; ,'')r, ,..~..dL;iJ.tiOIJ
TOTAL '~v'0,2-234(~). Y 1!l. 90
Shared Drive(T:)/Building FormslElectrical Permit Application I-06.doc