HomeMy WebLinkAboutPermit Electrical 2004-2-2
as submitted has the following
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FWN~I~54t1lf7ilka6a9 require specific land use
approval.
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ELECTRICAL PERMIT APPLICATION
City Job Number COM 200<-( -0007 L Date
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LEGAL DESCRIPTION
17os-27'S1
04 S'Q,O
JOB DESCRIPTION
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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 1'80 days.
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Electrical Contractor G e...-o. rei. <E.( ~
f.?". Rcl
Address c3 ~ 5 'f /10-4 cl ~
City Sp+ { c1.
Phone '7'; 1- 2S"Q f.
Supervisor License Number 3 {; 51 .5'
Expiration Date /0 "/ -D </
Constr, Contr. Number 8' 7' 4 5
Expirati,on Date 1/ - /6 - 0 .:..;
Signature of Supervising Electrician
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Owners Name S1"' v';~,-<-~+ ~-~ (
Address ?o ~o)<' 'ZL/ bO is
City ~l.l (.-E /1/ e Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent
Owners Signature:
Inspection Request: 726-3769
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Service Included
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
~"1>.~-'",_. -'".-,~.~; "~'_:'_''J.,.~_r-.t~~0~'~~7'''''\;-. -, ,.".'
B. eSer-~.id~sror Feeders ~InstaIl3tion,'Altera'tio'nsto~Reloi:.ition: :\,1
~~"'f_pJ.,_.....:r ."'~. ", 'V. .-' "'.::;I'.i.I~...:!~~t.::..:.<d'-~(c-...~
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsIVolts
Reconnect Only
$ 63,00
$ 75,00 .
$125,00
$163,00
$375,00
$ 50.00
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C. ~T~mpifr}lfy"SerY~~e~~or;;~e~d~fs,'~~~iE~}~' l&~':;. ~:'5~':.1trJkx'.J
Installation, Alteration or Relocation /'
200 Amps or less $ 50,00 Sb
N0l1Q)~to 400 Amps $ 69.00
11A'~MIl1l>$~h. EXPIRE IF THE WOOllo,oo
D.ftL1:::I~~~~~ltA,~it'~\iA~~~c".~?, ':>,.,'~
~:t~?;R~~~~~~ge~~ion ;::';aner .'.' \1,'" .]
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43,00
$ 3,00
E. U~\is~;!l~~i.ou~i(Se;\,j~",f~'ede";-lIot )J}~iu.d~d r~Ea~h' !~fi.lIa'ti~1I1
, !\ITION'Oregon law reqUireS you, .~
Pu'liJi;t"&IITI/lalioriq ted by the Oreaon \$1'5000
sl~Wt~h~p~<:lJ\twrr Those rules are sSlM;{fQ
Em\\~~rg4;~~@~hrOUlJh OAR 9f$2t~6b
L~Sdf8;~lI'&pQJlll'erClllICOPies of the r$'!t350~
UU1:l ' INote' tne 1I""..,t\one
Minimu"!:!lI~c~i~l~rm~~~"e~tiOl!ff~~_e~iRp.mfu\liChargeS
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7% State Surcharge -'
10% Administrative Fee ~<,) '""
TOTAL
58~
Shared Drive(T:VBuilding formslEleclrical Pennit Application 1-03.doc
221 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00072
COM2004-00072
COM2004-00072
Payments:
Type or Payment
CreditCard
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Receipt #: 1200400000000000146
Description
Temp Power 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
djb
Check Number
Batch Number Authorization Number
Paid By
DENNIS MElLI
000289 000002
City of Springfield Official Receipt
Development Services Department
)(
Public Works Department
Date: 02/0212004 8:56:41AM .:.
Amount Paid
Item Total:
50,00
350
5,00
$58.50
How Received
In Person
Payment Total:
Amount Paid,
$58,50
$58.50
.
.