HomeMy WebLinkAboutPermit Electrical 2006-5-17
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DATE 5-,.; -Db
SOURCE Mw~
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERJ\.1IT APPLICATION
City Job Number COWf2c>ob - 00 ~ go
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C. ::TeIllPor~rySehi~~<,orc,ff~~erst~f
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0\\\' Oregon laW ~,rc"an U'li\\W
{\ lIE-NIl . lnstaHatiolij 1\:1t'era'tio'oc2r- Relodftion
II W rules aaU\..iL~':;: f"I a ru'.8S 2,~~ ";:" .-O~- I
10 0 . C200rA:mp~0r>It:~ss 0 ~ r O,l?-O \ $ SO.OO
.~. atlon v' .." h Q\ 1"'\'\ ' , \ ~ .-
Not\l\C f') 02()ll_@['mp(\s\or400'-JAmps'-;>(\..\'85L'1$69.00
"R c5~- 0'. . ~\'~ \..). ."~
in Uf"\ ::J rfAOjatrhp\J\~?600vAmpS"\8)\ ,0\\3 $100.00
0030. '(au \~ tar (f:)''J:.\ - ~..' "",0\1
calling t~(0y\ct:~~c~Rs'L9n'\~'q?0.~\b\~fsCS~e "B" ab?ve.
numbelD9C ~fanc4}Gj(,Gilit's'."~ .J~"':!'
ceflte\'l'3 j "'. . "
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
1.
LOCATION OFINSTALl4TIpl'{;;
L{ <; '77 . CAM e-tf"A ...
LEGAL DESCRIPTION
17D2 "3Zl.{S
JOB DESCRIPTION
IEM I :t>.,.,..,El\..
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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.;\ CONTRAG1'9RJ!'!~tifLAf!()!l6NiJ/
. . _' ,"'_,:"'".. ,:-, ',_" '_~ "'X.;:'~ ",.~ . _,.., _; ,'< .."."",.:"': ',,' '~^''''~ ,..... -.... . ,;...->.i ., ..'.
Electrical Contractor
/
/
Address
City
Expiration Date
Con"L ConlL N,i...
Expiration Date
Signature of Supervising Electlician
Owners Name ;J/;I,fce- '2f~-J(eY' ~k~
Address g""06. ~ T?tU'-r~h,-- ~cl
City S rr'=- 0 Phone 71/6 .. Df <7 Y
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or re 1.
Own,,, Si~'":AJj\i
V
Inspection Request: 726-3769
$;/7 ~ b
. '. '. ...... .... ...,"': t... .
3. . CONIPLETE PEE SCHEDULEBELOll'
Date
,....,.:, ,'~, ...;;..~-""
~. ::..../.:.--: .,,::"~'i., >" .":,,,'.' ,'" ". ,-' ,(I', " . ~"_' .;
A. ..New Residential~Single orMulti~Familyper d\\'elling unit.
. . .'" .:' ..' . "..":' l.' , ~.,' .' ~. ,,)., .-' .,'
Service Included
1000 sq. ft. or less
Each additionalSOO sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$SO.OO
f' <~'" ,. "~':'~: .;.._;.:.......'..,' _:-"' .{, ';r .
B. 'S~rvi~es or Fe~der's:.i:~staliati()n;Aiteradon~ or Relocation:
:;_"',~._~:, ;_,:"_~__:, i~,~-':' w'", - , \,' ,),'__',\. .,:-", .>....
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 7S.00
$12S.00
$163.00
$37S.00
$ SO.OO
~C>
$ 43.00
$ 3.00
-I-
E.'l\1i~c~II~I~~.~~~,(~~~X~5~!~ eed e r 110 tlIlc1uded)- Each Inst,alla tion
. Pump or irrigation ~\6ft9~~~~
Sign/Outline Lighti~g '-Y9\?t \~~~~&S \'1
Limited EnergY!Re~i'Gientiak:,\\~\..\.. \\-\\S ?'t.$ .251)~(J\\
Limited Eri~~~/~~~ia~~\)'t.~ ~~~~\)q'~~0
\fi\~' \l'tV \-' I'
Minimu!11 Electri1\tefrtH'.n~w~'Ct~~'~\5 .$45.00 + Surcharges
'~nki\\~\'i;,;;^"('\\~, ?\;::", .. '.
:-o:\\l" ~. W!.. .
4.,S(TBTOT~N{1~(,);. ,,' . 5"0
'(
s;-
~~
8% State Surcharge ~.
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FOl1l1s/Electtical Pelmit Application I-06.doc
225 Fifth Street
Springfield, pregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-00580
COM2006-00580
COM2006-00580
COM2006-00580
LDP2006-00073
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Plan Review Same As
Temp Power 200 amps or less
+ 8% State Surcharge
+ 10% Administrative Fee
LDAP Short Form
Paid By
MIKE BLANKENSHIP
C!....., of Springfield Official Receipt
elopment Services Department
Public Works Department
1200600000000000663
Date: 05/17/2006
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
djb 10 142 In Person
Payment Total:
Page 1 of 1
8:40:16AM
Amount Due
100.00
50.00
4.00
5.00
300.00
$459.00
Amount Paid
$459.00
$459.00
5/17/2006