HomeMy WebLinkAboutPermit Electrical 2004-5-26
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ,
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ELECTRICAL PERMIT APPLICATION h ~ Thefollowingprojectassubmittedhastli owing
C'ty J b N b r. {I. Cl, /,,_.:- .~ '" 0 t,onlng, and does not require specific land use
I 0 urn er l OIMl-D04. -- 60 "\ ( Date ~ :) I c.- I 'Ppr9val, L/Yl3
1. LOCATIONOFINSTALLATION 3. COMPLETEFEg~~CH..I1YJ~V. .
16' ~ "'3 S H /€::Lc..e c..-' "HAutho~'(!J Signe~ . ~
LEGAL DESCRIPTION -----., A. New Residential- Single or Multi-Family per dwelling unit.
17 Os. 27 ( 0 0 3<{ D ( Service Included
, _n'. 'r
2. 'CONTRACT~R INSTALLA~ION ONLY B. Services or Feeder.s 1\t~t,~AlteratiOns or Relocation:
Electrical Contractor ) ~ 1<E2/E C7J11l/ 4: /A./<Z- 200 Amps or less lU Lf $ 63.00 .../5 c -
201 Amps to 400 Amps $ 75.00
, 401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsNolts \ W-fe-~llireS '!i3'4,~~O
ReconnectDnIr\oN: Oregon a t,; nv~.Q9\1l)U'O\~
~,"E.N dopted by - @ sst 1ort~,
C. i T~JR,'b9~r~~~~fttlf;'-~9F~\I~~~~\W'~~~O~o...
\Mot\~\Ca.i\ '0. 01.00~ 0 ~'l()~ip), dl (\in,Q \WJ%~ fg~' .
,-\t}.f\ 962. \ (G~~\~ <,Q,u 0lu
Instahatithi, :Al~'l~~~ol~a ignS"Cl ~G~~\nQ
lTh090. \10 ~, r? n\\\\Ol Q. ~" l\'mff'~\tffi'1f\'\
200 Amp~f\\\i~)l.U1@ ~n~Qu. c '1/ t}~t\\\il \N)@!Bu5(f.Orr--
20 I Amp~~~~IA1)\'~@ O~~Q~~,,~o69.00
40 I Amps to 600 ~fbpY'~ 10 u $100.00
0"
-:::> New ~lte~ation or Extension Per Panel \S6
~ Ou.:.-GirCUlt * $ 43.00
Owners N~e B~ N Lo~ ~~~~~~:~~:~:\tO'~? $ 3.00
Address ~ ':3 S .:5 ~/~r' /' c...( E. Miscellaneous (Service/feeder not included) -Each Installation
// ---.J (f>~o - - \f 1\'\E WOR~
City 5;:::>RI/<i:}/-/IE"L]:j'hone OOfD)I~~ . N'8f~{.~ilt?~E 1 \S ~Ol
I' 1H\~ PER I~'M~'[t\iRe 1h\1~igER~6 fOR
OWNER INST ALLA nON i\U1HO~~~~i0~Ithe~~P.~~tial
!he in.stallation is being made on property I own WhiCi~~~ 60 6-~i(ealfi~~/Commercial
IS not mtended for sale, lease or rent. Minimum Electric ~nri~p'ection Fee I
. /~' --
Owners Signature: 4. SUBT,QTAL OF ABO~ :r~'\ 25 z..
-/ It
7% State urcharge 'tl ~ -s~ ) , 7 bC{
~::A in~~pF<< ~ 2~~~:
T:VBI.lildinl! F trical Pennil Application 1-03.doc
JOB DESCRIPTION
~#I 5:- C-N'Z~Az; t.A//~.--q
Permits are non-transfe;able and expire if W/k is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Address /1 ClZR s,€ be, G-S)~ ~ .1 -0
cityd...c~~Phone ~
';:::v.:s:- p't:. - <<!)Z2 ~
Supervisor License Number ,~7 s
Expiration Date //":;)- / - 0 9'
Constr, Contr. Number
RS-R9tb
Expiration Date
Signature of Supervising Electrician
~
Inspection Request: 726-3769
~. .\~~ r/\tM
\~~~\.:\'V
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
Over 600 Amps or 1000 Volts see "B" above.
D, Branch Circuits
$ 50.00
$ 50.00
$ 25.00
$ 45.00
225 FIfth Street
,$ptingfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00149
COM2004-00149
COM2004-00149
COM2004-00 149
Payments:
Type of Payment
Check
6/912004
.
RECEIPT #:
Jiiily of Springfield Official Receipt
~elopment Services Department
Public Works Department
1200400000000000874
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
BILL V. DUBENKO
Received By
ddk
Page 1 of 1
Date: 06/09/2004
Item Total:
Check Number Authorization
Batch Number Number How Received
1670
In Person
Payment Total:
lO:21:39AM
Amount Due
6.3.00
156.00
15.33
21.90
$256.23
Amount Paid
$256.23
$256.23