HomeMy WebLinkAboutPermit Electrical 2006-1-5
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)7f62~~- -
ELECTRICAWftRM1T A.PPUCATION. . / oate ---
CityJobNumberC~ -1)60:2.3 Date'; /(}6/;;)tJ?;~ ,oollzedSigna'U,e .
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1. CrIJ:ToCATION/bP.ffNsfA!f!&ifioiY "'111; ~~~ 3. !teo:n;IPi1ETE'fEEE'SGH'Eiiti.tiE!BEEew.:'"~"~"~Y."l
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LEGAL DESCRIPTION A. 1~~r~~~~iil~!!gi!I;;;!!iqgl~,!!F_l\l!!~tjzf'!mily;p.e~,.'!ir.~!!i~g;j1,nit .~4
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JOB DESCRIP'I'ION
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Permits are non.tranSfe:b::-:d4Pire if work is Each Manufact'd HDme or
not started withiD 180 days of issuance Dr if wDrk is Modular Dwelling Service or
Suspended fDr 180 days. . Feeder
i1"';;;\"";~'1''''''~F~~~;:W~~'''''''1'''~''''''''{lt;'J4''''i''{j'll..",....~ :;..;:",,~...,..,.........,i:; ij'!'T~~'j;'~"';r*i~'''.v1(\'~<';<I1~$":!'11~;;;l>-?,;.......,~~~~J1.;;f.tn--~"~~~''~;t..,.~"~;;tr.l
~-ii<!NiTRACT.OR1NST'i1IJEATIO 'ONL~ B. i;Ser:vices,or'Feeders--""'Ins{allatiow.-lI1tenitiooSto"iRe!ociltian:'l.li!.
:lectn:a~:::::"C~f:;;~[~'~ 0uCJ 2::~~';;?{;~'&~~P:c;~;~~~~~~i:'Z'3"~.'.CJD
P /I B 20IC~'!.'Bs tpo1pO AmpsIJ81 0 throuqh OAR $!!2'(~OJ1
Address U 0 X -12.{) / (P 401 Amps t~160~,'6fsblaln caples of Ihe$.125.00...
.....~.IJ 1;:1 lfle CE::nter (N' -....."".....
601 Amp.s:tDIOOOA~s' ole, the lelel$163'00
City bUgrlM,.- q7jf>>$ne ~ {fl /2.S9 0 Over IOOO~A~~';N.~I'fs uregon UlIIllY NOlifS315cW
.~ v _<1,,,, 1$ 1.8003' .
Reconnect Only , J".~;j44J. $ 50,00
<J. ,r:; 535
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Constr, Contr. Number J ,\ ~ l?Jh..o-.cf,.r><!-
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It) 11'1/01
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Supervisor License Number
Expiration Date
Expiration Date
Signature of Supervising Electncian
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Owners NamSb JA fl.J ~dZ.J5if)C1y
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Addresspm Qt ~ pU ;S I
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OWN;R~STALLATION
The installation is being made on property I Dwn which
is not intended for sale, lease or rent.
Owners Signature:
IDspectlon Request: 726-3769
Service Included
1000 sq, ft, or less
Each additional 500 sq, ft. or
portion thereof
$106,00
$ 19.00
$50.00
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Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69,00
401 ~WfI'e~O Amps , $100,00
OVilt:m~ove. .
D. ~i' '~-'ll~ffl9~tw~~~~~l
Ne.e~MW:~{~iW'l\Umf~e'l!JEb EO~R NOT
OnAf\l~Jag (JAV figlMO $"'43.00
Each Additional Circuit or WIth
Service or Feeder Pennit
$ 3,00
E. ~~~~li1fff~~t('si~wr;tJtrtigt1fi~hilr~aE;~i$rW~Iiti~~.
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Pump or irrigation $ 50,00
Sign/Outline Lighting $ 50,00
Limited EnergylResidential $ 25,00
Limited Energy/Commercial $ 45,00
MiDimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. rS;;;~~rAEOE~O.VE1,~~~.-"",~tf-l-;i1b/3 60
~:;'..'l'a~.:o->;t'''~~~'''~':;:'',-~o;:fu-:}~:!'it...,':!':\f~~'''~'~i~~~.UB\.o .
. ~% State surcharge' . ~~ 6 . () V
10% Administrative Fee (p. sO
t/;J14. 3</
TOTAL
Shared Drive(T:YBuilding FormslElectrical Permit Application l...o3.doc
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225 Fifth Street
,
Springfield, Oregon 97477
5'11-726-3759 Phone
Job/Journal Number
COM2006-00023
d?M2006-00023
Q)M2006-00023
Payments:
Type of Payment
CreditCard
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1/5/2006
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RECEIPT #:
Description
Perm ServlFdr 200 amps or less
+ 8% State Surcharge
+ 10% Administrative Fee .
Paid By
THOMAS LEE BALCOM JR.
GP~
~
JilY of Springfield Official Receipt
_elopment Services Department
Public Works Department
2200600000000000011
Date: 01/05/2006
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm 061108 Phone
Payment Total:
Page 1 of 1
lO:52:39AM
Amount Due
63,00
5,04
6,30
$74.34
Amount Paid
$74,34
$74.34