HomeMy WebLinkAboutPermit Electrical 2008-5-12
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (541)726-3689
ELECTRICAL P~IT~. 'PLICATION
CIty Job Number . ( 'r7. .... \f1 ~
- .. ~ .-
1 LOCATION OF INSTALLATION: 3 COMPLETE FEE SCHEDULE BELOW
401_f'J ~n<tY\ ~i1;per
~~;bU1~\tN rol~)~
~~~TIOWm{ ~~
P"m." '" ~-t"n",,"bl' and exp'" .fwo,k"
not started wlthm 180 days of Issuance or If work IS
Suspended for 180 days
Over 600 Amps or 1000 Volts see "B" above
SIgnature of Supervlsmg ElectrIcIan D Branch CircUIts
A ~ - ) ----- New Alteration or ExtenSIOn Per Panel
~c:aA/ ~ One CIrcuIt
~_ \ .. Each ddltlOnal CIrCUIt or wIth
Owners Nam~'€lrm J'C~ \0\\1100\5 \L r \ ct~C@:mt
Address \oC\.l 0 CD.)\ tnJ (11 ut) llct Mlscelt)ip:qSuPSRM'~I9fi~aP1R2tfl' M~atIon
c,ty fl net\ ~on' _ p, \, ~ Ictqq Pnmp ., ~~~~~~ ~~DI~~~~~ri5fM\ToIS NOT
AI I r:NTf~1 ut slgn/out~mft1f~~~AY PERI ~~Pc/60K
foU5lh"~.ItllfdPl~ft,~wg, res y~ to LImIted EnergyIResldentJal OD. $ 28 00
Notl~atiofhmenoors ~91Md.:An whIch LImIted Energy/CommercIal $ 50 00
In O~tlQ5a~te~r~pf952-OO1. Mmlmum Electnc Permit InspectIOn Fee IS $50 00 + Surcharges
0090. You may obtain copies of the fu~es hu ~ c:::: a:>
ca~tvge1b~~ellthJf. (Note: tr.e tS!Sphoneu" 4 SUBTOTAL OF ABOVE u~.
numDer !or the. Orapon Uilhtv NCltlfif'.l'ltioft l-V./iilo State Surcharge LP.(d)
lienter IS 1-800-332-2344). 10% AdmmIstratlve Fee ~ . <5cJ
5% Technology Fee 11..-. \. c::.
loC\ . ZG
2
CONTRACTOR INSTALLATION ONLY
ElectrIcal Contractor Sfl!-i-rnv- E:Le(.,:7tC../,l... .pi'<..
Address '6~1'J..'I ~rvl..-c::. JcvlL
CIty Cf4!!. (V'eM- Phone ?<ls ... 1.l.11
SupervIsor LIcense Number V & b L/ .s
ExpiratIOn Date ''1l - '\) J -0 '1
Constr Contr Number C ~r'lP ,()"'\.f~
I
ExpIratIon Date ,:) - Jl\) ,()t:lJ
InspectIOn Request 726-3769
~K
sqt6. t1If)
Date
A
Ne\\ Resldentlal- Smgle or MultI-FamIly per dwellIng umt
SerVIce Included
1000 sq ft or less
Each addItIOnal 500 sq ft or
portIOn thereof
$11700
$ 21 00
Each Manufact'd Home or
Modular Dwellmg ServIce or
Feeder
6SPO
\
$55 00
B Services or Feeders - InstallatlOn, AlteratIOns or RelocatIOn'
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 70 00
$ 83 00
$13800
$18000
$413 00
$ 55 00
C Temporary Senices or Feeders
InstallatIOn, AlteratIon or RelocatIOn
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 55 00
$ 76 00
$ll 0 00
$ 48 00
$ 400
TOTAL
Shared Dnve(T )/BUlldmg Forms/Electrical Pernul ApplIcation 7-07 doc
225 Fifth Street
Spnngfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2007-01738
COM2007-01738
COM2007-01738
CO M2007 -01738
Payments
Type of Payment
CredltCard
cRecemtl
RECEIPT #:
DescrIptIOn
Manufactured Home ServIce
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% AdminIstrative Fee
Paid By
SPRINTER ELECTRIC
CIty of Springfield OffiCIal Receipt
Development Services Department
PublIc Works Department
2200800000000000641
Date: 05/12/2008
Item Total
Check Number AuthOrIzatIOn
Received By Batch Number Number How Received
llh 163364 Phone
Payment Total
Page I of I
10 15 48AM
Amount Due
5500
275
660
550
$69 85
Amount Paid
$69 85
$69 85
5/J 2/2008