HomeMy WebLinkAboutPermit Electrical 2004-2-2
".
. I t e' I
. t as submitted has the following
225 FIFfH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F ~~~~d'7.'2~_'!MrJnol require specific land use.
ELECTRICAL PERMIT APPLICATION . 17_ /r . Zoning. 1..-1)[2... _
CityJobNumberCOM2.00<t-r')oobb Date ~/7' 0<-( Oatr 2-2-o<.f '.
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LEGAL DESCRIPTION
170"3>"2-731
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 f80 days.
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2. ~Sd&:&t8;9~.~$T~~,t{Q~~9!yLf:~
Electrical Contractor . G e v-o. rei: cE.{ c.c:r-
Address
c3<15<f r/o.-<,d~ IS... Rcl
City Sp+ I e:I.
I
Phone ."74/--' 2:)"9(;.
Supervisor License Number 3 {," 51 S
Expiration Date 10 "1 -C> </
Constr. Contr. Number g 7' 4 5
Expiration Date /1- /6 - 0 '1
Signature of Supervising Electrician
A <:IA-<. ~
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Owners Name 5-r ';,,^~-+ ~YAJ (
. Address "?o l1.C1< zct {,O Z
City b-v-.. G-&( e Phone
OVVNERINSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
~~~:~""~'(~~~~n"''r'~-;;'';_';.~-- ;':~'_" ';;,,~.>.-" ~\";'::.;.:gJ'~'~'ft~'.I~$"').,'11o~,......; 9 ~~v;.'''':'l
A. ;iI.Nh~~es!~~~tial '" Si~gl..".orM.ulti-"'!,l1lil~ p~r dwellingYUl!it(~h,J
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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
B. ~~s'ioriFe;d1~'s:~'iri~ih~ii~~il.r:rt~~~~r:.~i~~~i:tio~~l:'; ..:~
.~. -", ,. ...,";i(>O;>:J.a.:-::-.~._; .~" .'. "~;"',:'~:':'_~~~th..-~'L.J
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
r~T~'" .t. -, " ... ,.-' l~ .' -4.. . . I"", . ,..L-::''H
C. ~mporary'SerYi~~s.or":feed~"rs ~Y." or h ~::t'". \/ ~~~
NOT1C~: ~~JBE IF THE WORK---
Instal!.IIen?JiilM~li~4\.:~H1~:;~~~T IS NOT
200 A.MPI\:l,QWED UNDER 1 . ~e9\OO :;<:::>
201 A6filMMfOclCfJ;j,pR IS ABA $ 69.00
401 AtIlP\l<t~&\bIA~fERIOD. $100.00
O,:,.er 600 A~p's <>rJ290 Volts sce "'B" above::..........
f;~ / . .,," c:'. .. . ... .," .' . ''''.
D. r.J~r!l~~h'~it.~~jt~;~l<~t. ....;. <<j "_. '< '-{-
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Servicc or Feeder Permit
. ~;/'3",:"~ ,1 .
.1
\
$ 43.00
$ 3.00
E. hBr{~~H€f~~s,(S~r~]~e!f.~~e~,~r~~~~}j!~I_Udrli~';Eac'~ "~~~til!riti~l 1
ATIFNTION:Oregon law reqUIreS you ~o
foll/iiw.~gs _\l.9d by the Oraoon UtihtY$ 50.00
'IOtifiJ1~~\1~W.l1id~.h~l'8>se rules are set fors 50.00
I OARitY!!~@y~tgYlRe)itlenti3gh OAR 952-00$ 25.00
0090.L~~n,e"8~Jeiiilme;ci~s of the rUles's 45.00
. "'0" >tAr /l\1ote' the tel"~llu""
MiiiillllflDlEleelTferl'erfull In\!lecti~'N'<ffiM:~i\:II9 + Surcharges
numb~f-199be O[egQIl._cl~H 2.-. " 't ,--;-~
4. r~~~~~:;'Q~.f1l6.'fE..?3~.t). ~. '~.~";'2.' 50
sS-o
7% State Surcharge
10% Administrative Fee
.:;-o~
TOTAL
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Shared Drive(T:)IBuilding Forms/Electrical Permit Application I-OJ.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
JobfJournal Number
COM2004-00066
COM2004-00066
COM2004-00066
Payments:
Type of Payment
CreditCard
.:
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Receipt #: 1200400000000000147
Description
Temp Power 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
DENNIS MElLI
Received By
djb
Check Number
Batch Number Authorization Number
000289 002461
City of Springfield Officiaj'Receipt
Development Services Departmen(
Public Works Department
Date: 02102/2004
8:57:43AM
Amount Paid
Item Total:
50.00
3.50
5.00
$58.50
How Received
In Person
Payment Total:
Amount Paid
$58.50
$58.50
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c. '0_
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