HomeMy WebLinkAboutPermit Electrical 2004-9-21
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number CON\ ZC04--011 $1S' Date
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LEGALDESCRIPTIO{ '70~7.-7/() ('
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JOB DESCRIPTION ~ ~ "'-
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Owners Name K"Gt.N'Y JU~F(:;;fd'
Address "bj 2__~.rf/~7-.";\ sr
. City lSJ> rl::::::. Phone' Pump or irrigation $ 50.00
\ - sigbV(D@NUdmijh@J:l}gon law re'1llir~C! /;GJt.ao.oo
OWNER INSTALLATION LW~~WE:h~f.lfy.lRiisi~nia1Y the Oreaon Ut~i~.OO
The installation is being made on property I own which ~tb~RB~~Mmlkfat;e rul~s are set $:48100
is not in~,~.j~ ~~e, lease oc cent Mini~~;!~,~~llil~~~~\~:~~a~f~~nccl'acges
Owners SfgIliilUfei:Rtv;iT SHALL EXPIRE IF THE WORK 4. ;~.S6B:f~.~~VE~).h~ ,t~I~?~<f~~ '. $-0
,[; ~ UI\JULM THIS PERiVlIT IS NOT .rrlumtier for ,Jl~ Or~Ol'tUtlHty N01mcatlo'n ..
7% State ~~fltW~ 1-800-332-2344), '3 SO
10% Administrative Fee scr 0
$S8~
Permits are non-(ransferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for.180 days.
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Electrical Contractor ~ -.r"I ~." S\,\'l/\
Address l..{ ~V C-",^(...c)\',,^- c:;..\:-
City _~a.1)~ Phone ~~b-<=1~C
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Sllpcn'i~;or License Number (/ S" 5 ~'XG
/0 -/ - 9'\5
Expiration Date L.)
Constr. Contr. Number 1. S:< ~ R~
Expiration Date \ \ 0 1
Signature of Supervising Electrician
"/" ~1'",",\I:'l n rlJ Ie 11,],I.,III,\.\!Cn FOR
'"" --"1~;'\'I"',III_"',_ _". IV ""'" ll\l"""VI\l........J
/'.,~'{ 1 eu lJ/W PtHIOD.
Inspection Request: 726-3769
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Service I~~ed '.9~, 9v'i-e I~e(y ~
&(y ,s>,oe q,s>
1000 sq. ft. or les~gl).' C'i~" /1)&), 06.00
Each additional 500 s'rf".ij:. or .... <:tl)(y :o~~
portion thereof $ f~.o(?
Each Manufact'd Home or
Modular Dwelling Service or l.c
Feeder .
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B. : ',Ser~'iI;es'9rFeedefs.':' Ins(allation, Altenitions-orRelocation:, ~. .'
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200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
5375.00
5\ 50.00
, .
c. . TClllrorar:/ Services or Feeders
Installation, Alteration or Relocation
200 Amps or less' $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above. .
D. L~i-~F~E:Si.~~tii~I~'"':;~~7~,';T'=.~~' ~'.:~' ..,.... '.' ;~;"~.<'~; ~:::'
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
. $ 3.00
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E, '~:1\1isc:eIiline~us':(S'et.YicClfeedernot inchided)'..,:iadi lristallatioi{;
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TOTAL
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Shared Drivc(T:)/Building FonnslElectrical Pennit Application 1-03.doc
225 Fifth Street
,
, 'Springfield, Oregon 97477
541-726-3759 Phone
.
~-
aity of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001367
Date: 09/21/2004
10:21:55AM
Job/Journal Number
COM2004-01158
COM2004-01158
COM2004-01158
COM2004-01158
COM2004-01158
Description
Sign - Outline Lighting Each
Sign Plan Review
Sign 0-35 Square Feet
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
50.00
40.00
80.00
3.50
13.00
$186.50
Amount Paid
CreditCard
JOHN G CHAPMAN
dIm
021424 In Person
Payment Total:
$186.50
$186.50
9/21/2004
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