HomeMy WebLinkAboutPermit Electrical 2006-10-19
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL P~IT APPLICATION
CIty Job Number ~n . \ ~. Date
1. l!>.1JOC'ATION..';OF"".i!NSTAL~170N;:~'~~
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JOB DESCRlPTION
. )e~n~~a:r~~~~~~t~~
.r not started within 180 days of issuance or if work is
Suspended ror 180 days.
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2. -',,' >' ~~~'~i'\\'I''1!"":,;;,~~,:!"""."...,..,~...,,.,-i:t~'''~~-r.ll'N,~~~'~,,~---iJ
Electrical Contractor ('}t!JRet/)s /N('/
Address /CIhS- oj, i 771-
City &(JeNe Obhone C;f)~-G(J()D
,
Supervisor License Number '2?9 g L6A
Expiration Date ItJloI 12CX'J~
~.. '-, "'OF' ,__,~~""",";"t'"lr..,"m:;..~'i::""_~:;;-~-~'~.Q.~,.E:C:_., -iN!" /C' ,~~~~l"--(_. ~~,tif - - P"~ ~
3. ;"COMPLETE:PEE;SCHEDULE"BEEOW' "';":",.","",l',,,,,~::;:;,,",
.,' .4i:""-~,a:u~;".;i;.~~~,-"",,,,,,,,,,,,,,,,.,,,,"~.~{\~.~,,,,(rlf,!"\~'"I~~.
A. f~~~;r~r~1ti~r~1irrll~~~T~f&iii~'F~~TI.-~~p.~Wfi',,:~i~i:.w~~~
li:tN1..~"'--""""--'-" ""':lr~';;;o.~::":'~~.::-~,;o..:_~.::-t~~'" :'
, Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereor
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50,00
B.~S"e"~\q~~:tif F:fd~~iJ~tta.;ll~~tY~~~ :A:.i~. ~'~t.i~,~~.s:gi~'e. "lri61r.hf~/~~~J
....... ,:;.., . ~<.,. ~"",,,,'~,J..~'_~"""" '~"'.~J:rii!)"'3~'~C'.,~ '_ ,.,.~...,.,...~, .'~.'3,:':r. "1"'iH"'!~
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
$ 63,00
$ 75,00
$125.00
$163.00
$375,00
$ 50,00
~~:~ o;'.mJ'~~\ol!..' {:(":l. ;~:I.. . ],1', .._~'" !k'_''tt. ';-''Z'..~. "'I:i'~f ~.,t-J;~~."'.~' . 1 ',~~""';,,*f,' _~.. ..lo~-r:~: :'~lil~
c. . rr~~ppr)~r-YiS:e-!~~.~.~~~r..~f e~(.I~r.'~~~, "'{:';~;,.t"J!tt:,:; ~f,:~~~~t '.."'f"~ ~iSE
Installation, Alteration or Relocation
$ 50,00
$ 69.00
$100.00
200 Amps or less
Constr. Contr. Number / 29 ? .3(, . 20 r Amps to 400 Amps
/ ,/ _.....-,/1 I 40 I Amps to 600 Amps
Expiration Date (,/CJ9 perk> ~. ~ Over 600 Amps or 1000 Volts see "B'; above.
nu IllIt:. 1iE~',:lI" ~.)'4'.-:~,:J<io('r>f'fftn )~~~~Nt"., .fL:'tg,J."i'(;"" N1r.fv' ~.\'"
Signature of Supervising Electrician THIS PERMIT SfPn-LE~ffi~I~YffiE.W.\UR!<':' ,>t,,~c'\~ :":'~~"';;~~"','3I:'"~:!\;;'~
# -/ /J /JIll /J. AUTHORIZED UNDN~,;rl\ifeJ?tiIlMlI illitOOilm Per Panel
~~ .//.f!/~ COMMENCED OR 16n~'a;iINGtONED FOR ,I
, 11_ ANY 1 B. 0 DAY PERlWl., Addl.'tio,.na,l, Circ.uit or.w., ith
Owners Name \\\ \~P. <:il\\Sef\ Service or Feeder Pennit $ 3.00
;:'lX\~ 1,~:1 ~~_~ L ,!:=:I,(iiWF<\i'''~'$:)55;00~'';0:0:lli~li!.i!~tjtW1
Sign/Outline Lighting _
OWNER INSTALLATION Limited EnergylResidential '$ 25.00 !1.C){:L'
The installation is 11l;liii;MtllOM:~lllvbl\!$dkes you td-imited Energy/Commercial $ 45.00
is not intended rorbllolitRll~ alIIopted by the OregonMlili\\lum Electric Permit Inspection Fee i(s"45~ Surcharges
Notification Center, Those RIles are set f~~"""""'_'''''W6'. "''''..c~.,. '::cl;; ","\'" :'::;;:'"">;':~"'V''1 ^ c=.. tY'l
Owners SignaturM OAR 952-001-0010 th~gh OAR 9511~~r,<l~t1f~~:Ei.~\~'~:;";;:~Jl>i:i,~~;~iLtil ~~
0090. You may obtain copies of the Rlle,l~ 11 l D
""'lIing.ttoA ""ntAr (Not9: the telepho~% State Surcharge. O. .p
number for the Oregon Utility NotificatiOIlO% Administrative Fee r. e~~ L\. ~
Inspection Request: 726_~~ter Is 1-800-332-2344). 'f~~ .~ ~() \ed1 LprilX"WAle., ) rL5
~ "_'___ Sh.red Drive(T.)/Building Fonns/Elect.;c.l Penni. APPliC.'E)~:tO
$ 43.00
" \..
225 Jl1fth ;,treet
Springfield, Oregon 97477
541-726-3759 Phone
f" ~~
Cillt.of Springfield Official Receipt
~Iopment Services Department
Public Works Department
RECEIPT #:
2200600000000001459
Date: 10/18/2006
11:21:47AM
Job/Journal Number
COM2005.0 1234
COM2005-0 1234
COM2005-0 1234
COM2005-0 1234
Description
+ 8% State Surcharge
+ 10% Administrative Fee
Low Voltage - Residential
Minimum/Adjustment Electrical
,Payments:
Type of Payment
CreditCard
Paid By
TRACIE DUNLAP
Item Total:
l.:heck Number Authorization
Received By Batch Number Number How Received
ddk 036924 In Person
Payment Totai:
Amount Due
3,60
4,50
25,00
20.00
$53.IU
Amount Paid
$53,10
$53.1U
I
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cReceinl1
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