HomeMy WebLinkAboutPermit Electrical 2006-8-18
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225 FIFTII STREET. SPRINGFIELD. OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRlCALPERMIT APPLICATION
City Job Number CfJ'rn ;:)(\11 (" - 010 Q()
LEGAL DESCRIPTION:
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JOB DESCRIPTION: c; (\11\.1 , b,~ \Cwcld 1000 sq. ft. or less
I 0 VJ\V , Each additional 500 sq. ft. or .
.f '1 'j' . th f
M:,E"""-"" .; l J L.t...L.Q' , I (r- II \ _ portion ereo
Permits are non-transferable and expi~e if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or $50.00
Suspended for 180 days. FN11~r'CE:
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Electrical Contractor ---rl/:Ifj.) TZJ Ai E( t?7J::t: 2Q.0:wnPS~"nm OR IS ABANDONED FOf\ 63.00 .
. '201~AinPslto!4bo AW1~JO[l.. $ 75.00
('0(.)4 h(j-' r#. Cf74,pS"01 A~~:t0600A,!,J'S ~125.0()
. . . 601 Amps to 1000 Amps $163.00
Phone 9 $S ":Q)~ 7 Over 1000 AmpsNolts $375.00
Reconnect Only $ 50.00
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Address e() fx;w
City fV.r;-
Supervisor License Number ;<, 0 I 7 .s;
Expiration Date f t) ~ I - 0 It. e
Constr. Contr. Number I J 10 "3:::l q
Expiration Date 1 (') ,.... } _ r') {,
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OwnersName"",.~( fu"""'llIA/
Address \(~2- \ L\ nden
City ~ n.j-H"}.,J. Phone 52.1 ~ -;)..S9)
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owner~ Signature:
Inspection Request: 726-3769
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Service Included
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A. ~~,'N cy;':.Re~id~l) ~i.al ~ :Si!lgl~.~o!,Nlulti- F n, ill !15:, P!~' dj~emrig .unit"'
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$106.00
$ 19.00
C E'-:r-'~;#. "". --;.;.\.-t:"'.'\'~~'''''S--:J:::;:''''''.'.;'\'''i''''''F..~ 'd"'----""'"". .,r:r.:,:r.:::~~~.:it ' ..fr"'rY:;f;:~r::...).:,,, ,,,,, i~':J.'Pt'
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Installation, Alteration or Relocation
$ 50.00
$ 69.00
$100.00
200 Amps or less .
20 I A~ps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
rr.. '!~_'l"'7:;.;~~:-::.' ;"(;7:~~'::;:.,..-,"1rr<: -~?"'~'~'I:\ <'FT.~"~~r ---:--':;:,,",<?'''"g':;'I':''-:T'l:'':;;'-~-''-,''7:t:f(
D. 1"Branch1ClrcUlts\""~:,'~.:' .J~~r: .;~:'..J;:-:::;{. '~f1~" ',i:',~ ~~'..: 't"':e1t':..-)."'",..~ '" ~.;~>~,. :::~-.\
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New A1teration or ExtensiontJ'yerIPll'nebgon Utility
("l\n'N rules aaopl"U "~'''. 'h .
One 9rc.~lt. r r.ter Those rI ilr/s are $r43\00' 4 3
E li~'A~d'd' :~"tlr.Ir.C'Je. . 'th 52 001
ac Illona IrCUlt/Or.WI lroug"''-{OAR 9 " -
'_Q,,,a"'/'lIJ1-.IUIU" " $300 ('"
Servlce or.Feeaer Permit. . ~ ..1_<:1 U,":"'" oy. .,.-
090 You may ootaln cO[J''''J ~, ... -'
P~~9~1;,<~~~:~~~r:';.'Cm:~1:;J'~'f:~:0-SJ~~,~,!,~g~q~{~-(<f5'f:~\!.<~"141~!f
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nUfllUl.;1 lv' cr.--v~-_, .
" t S 1 tluO-:.l32-2344).
Pump or irrigatiori,n er I - $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
f~':~:--' ,\.;J>r"'>;;:, :w~'-!X,'~,',r,::.,~",:.~;.<:-:...'.:'l;!ii~'1'.~'~~'-'"';-;:ji?;f:"' :;<",:.-;
4. [cSUBTOTALOFABOVE'f':I}: '.'t"ln",,~,,~"n
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8% State Surcharge
10% Administrative Fee
5%.Technology Fee
.5!J-, em
'-f <-10
,L;. '0)
2.'1.5:"
TOTAL ~7 (o!=,-
Shared Dnve(T:)lBuilding Fonns/EIl..'ctncal Pcnnit Application 8-06.doc
225 Filth Street
,
Sprmgfield, Oregon 97477
541-726-3759 Phone
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Ciail.of Springfield Official Receipt
.Iopment Serviees Department
Public Works Department
Job/Journal Number
COM2006-0 I 020
COM2006-0 I 020
COM2006-0 I 020
COM2006-0 I 020
COM2006-0 I 020
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
3200600000000000439
Date: 08/18/2006
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
ROCKLIN R. THORNTON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 218162 In Person
Payment Total:
Page I of I
10:27:22AM
Amount Due
43.00
12.00
2.75
4.40
5.50
$67.65
Amount Paid
$67.65
$67.65
8/18/2006