HomeMy WebLinkAboutPermit Electrical 2008-2-25
SPRINGFIELD'
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DATE ~' iN r\.A
SOURCE ,!\~Sr.! /
CITY OF SPRfNGFIELD, OREGON
,1---, 225 FIFTH STREET · SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
iY ELECTRICAL PERMIT APPLICATION
~ n D~ CIty Job Number COHoo1 z.c:>e>[{ ,. 00 zb S-
1. LOCATION OF INSTALLATION: 3. COMPLETE FEE SCHEDULE BELOW
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LEGAL DESCRIPTION 170:3 2.5'4. ~.J/ 81 ud A, New Residential- Single or Multi-Family per dwelling unit,
(11-j-~ ~ ~K___" OfoOz.. Service Included
JOB ~ESe~TioN
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Permits are non-transferable and expire if work is
not started within 180 days ofissuance or if work is
Suspended for 180 days,
1000 sq ft or1e~s
Each addItIOnal 500 sq ft or
portIOn thereof
$117 00
$ 21 00
Each Manufact'd Home or
Modular Dwe1~..!ce or $55 00
Feeder loi/~::1V170N.. 0
CONTRACTOR INSTALLATION ONLY B, services:'~1H:.'::~r::I!:'J/yWHr~f11or Relocation:
2, _ 0090 952-oo/1te1. 100 the Ore es Vat} to
Electncal Contractor ~(Sct-- ~ .~~ \f- tf/uj~ hA200 Amps ovJeith )'OU may -00101bti Se fUlefj a'fi@ Utility
. _ v U 201 Ampslfttlffl9;a~ Cen~btain Co:~gn ~D~9t~orth
Address 7; 9 cr IS- PrLU-..Y I -e..- ~'OCLL- 401 Amps to 600 'ifH!Jhe Oe; (NOtA:~fth1f3~f1~. Ot.
"""enlA I ego . "~tl '1't1Ie~ 0
CfV, ,':-1/ 601 Amps to 1000 Am)1f Is 1"80/!;.~tilif.Jt....N,f1Cf1?f9lan~ ~
fit! (~ 6:5 53 T? Over 1000 AmpsNolts -~2.23/~@~,etlOfJ
Reconnect Only .,~ 5 5 00
CIty 0.A-dJ!.A-'LJl W Phone
rJ I 17t1D;)-
SupervIsor LIcense Number 3 D s- - S k-G,
ExpIratIon Date ( 0/ r) V
l
Constr Contr Number
/&3Lf70
3\{~ ~ II
ExpIratIon Date
,/
SIgp: ,ture of su~ng ElectncIan
~\ 0 0
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PD r8 D X 3 D
CIty CO{ J vdl ~S ()r Phone 1& {P ~ J-~L{ l/
Owners Name
13-iU-
Address
OWNER INSTALLATION
The lllstallatlOn IS belllg made on property I own whIch
IS not llltended for sale, lease or rent
Owners SIgnature
Inspection Request: 726-3769
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less $ 55 00 '
201 Amps to 400 Amps $ 76 00
401 !frtft 600 Amps $110 00
oVlrH~~~ or 1000 Volts see "B" above
D, ~ '€&N~s
~Q~ ~:lI~J;~~L~ I
&wqPJ'f)~~[D (/~. n-lIS ~ r# rH~ ~ 00
Each AdOIMflIdPJfffiI'fr!cSJfNDQ fflVllr I,~,,:!.I(
ServIce or Feeder l'~fffMD. 'NeD Foii!>1vtJf'
E, Miscellaneous (Service/feeder not included) -Each Installation
Pump or lITIgatIOn $ 55 00
Slgn/Outlllle Lrghtlllg .;{ $ 55 00 110 < 0 ()
LImIted Energy/ReSIdentIal $ 28 00
Lrll1lted Energy/CommercIal $ 50 00
Minimum Electric Permit Inspection Fee is $50.00 + Surcharges
4, SUBTOTAL OF ABOVE
II D _ 00
"ls"?O
/[- '/;9:,
(p 5,~
J37-a--l
8% State Surcharge
10% AdmllllstratIve Fee
5% Technology Fee
TOTAL
Shared Dnve(T )/BUlldmg Forms/Electncal PermIt ApplIcatIOn 7-07 doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-00265
COM2008-00265
COM2008-00265
COM2008-00265
COM2008-00265
COM2008-00265
Payments:
Type of Payment
CredltCard
cRecemtl
RECEIPT #:
Description
SIgn Plan RevIew
SIgn 36-60 Square Feet
SIgn - Outlme LIghtmg Each
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdmInIstrative Fee
PaId By
ES & A SIGNS CORP
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200800000000000237
Date: 02/25/2008
Item Total:
Check Number AuthorIzatIOn
ReceIved By Batch Number Number How Received
dJb 025361 In Person
Payment Total:
Page 1 of I
8:22:12AM
Amount Due
8000
220 00
11 0 00
1650
1320
33.00
$472.70
Amount Paid
$472 70
$472.70
2/25/2008