HomeMy WebLinkAboutPermit Electrical 2003-3-6
: I ~-u CITY OF' ~_JINGFIELD, OREGON",-'). ..'~ '
.t. .
s submitted has the following
require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~~~)726-3689 f..-D(2-
ELECTRICALPERftfIT APPLICATION Zoning......
City Job Number (d)it 2d9('-~p.>Date j/~/OJ n~te . 3- ~- O~j"__'
. .J\uthoJized'SI~na\""11,...
I. LOCATION OF INSTALLA110N 3. COMPLETE FEE ::;<.:HEDULE BELOW
S-t'brl 4~,*
LEGAL DESCRIPTION
1M2 04- II "4~~CJ
JOB DESCRIPTION
~/~p'./f!?,,/~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
CONTRACTOR INSTALLATION ONLY
2.
::..:_:__1 '2ontractor 'J.tI~ #;/til1"tJ
Address 22S-6 -:1 J 4- fT"
City <) ,d,q)
, -
Phone 7U ..-2-760
Supervisor License Number
Expiration Date .--
ConSlr. Contr. Number J 'Z J J ?--
.
Expiration Date :? I / ~/19~
Signature of Supervising Electrician
f-~.~-
~
C/
Owners Name
Address
City
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
/-n'-t<..~ JI'f>J ~
A. New Residential- Single Of l\1ulti-Family prr dwelling unit.
Service Included
1000 sq, ft. or less
Each additional 500 sq. ft, or
portion thereof
Each Manufaet'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19,00
$50,00
B. Services or Feeders - Installation, Alterations or Relocutioll:
200 Amps or less
20 I 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
... . - -"'.-. -- .
C. ~:.!~mp~!~~y_Se~~~'~ces or Feeders
Installation, Alteration or Relocation
~,d-D
200 Amps or less / __ $ 50.00 -;)t:.J
20 I Amps to 400 Amps $ 69.00
401 Amps to 600 Amps . law ""1' ..,...~ ,$.100_00
A'-fF:l\l \ IUN:VregOIl . , " ,
~vefgRg~I}'8Mg ~\>MJYe!!y~eel\\B9iliQ'W,n ~~I;~~--l
D. Branch Cirfiuitsenter Those rules are se
NOll1IGdUV'V u_'. ..... I hOAR952-00-
N. A"''''t-'h'll'lGELnf\1.ot''pOlp!:\ I b
eWI,,> tera lOb-or xtenslOn er ane, the rules .
.. ,.. 'I( may obtain cople~ VI
OneJOi!cu,it ou .. c. h,r (Not..: t~: 'ol"'~)~:}!OO
Each Addlilfi~allIDlrcUlPor WIlli UtTty NotiliCgtinn
Servioe19r,'lte~d~r)PelmiDre9on 11 $ 3,00
f - :" - _CenleLi~ _1__8nQ-3~?-:~~""" -- - -- -- .. - - I
E, Miscellaneous (Ser\'ice/feede.- not included) -Each Installation'
Pump or irrigation $ 50,00
Sign!Qal\i\~hting \. EXPIRE IF lHS W!3f1.K
Limi'W\'\9~~1d~~ lH'C1. D(:RMIl\fdj~l
Limit~WIlI:~}~~'\S ABANDQNEOflil.&o.
Minimum BloQ~~~~~~V!f\'IUqn Fee is $45.00 + Surcharges
4. SUB~!~8~f~oVE . - -, Q1_~
~.>o
~QO
,5"~..'>O
7% State Surcharge
IO%'Administrative Fee
TOTAL
Shared Drive(T:)/Building Forms/Electrical Permit Applic3tion 1-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
COM2003-00065
COM2003-00065
COM2003-00065
Payments:
T}IIe of Payment
Check
Paid By
Description
Receipt #: 1200200000000000781
Date: 03/06/2003
Temp Power 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
DUANE KNIGHTS
Received By
Check N umber Confirm No
dim
4272
Page I ofl
3/6/2003
11 :06:04AM"'1
City of Springfield 'J>
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
50.00
3.50
5,00
Line Item Total:
$58.50
How Received
Amount Paid
In Person
58.50
$58.50
..
Payment Total:
cReceipupt