HomeMy WebLinkAboutPermit Electrical 2008-6-11
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225 FIFTH STREET. SPRINGFIELD OR 97471 . PH (541)726-3753 . FAX (541)726-3689
ELECTRICAL PERMIT APPLICATION
C,ty Job Number CarYl '2fTfJf,' - OVI.-/-.2"
S'~Of SUPt'1'?~Ele Clan
.... \ '--""'" '/l /1 New Alteration or Extension Per Panel
~ - c..J , 4A.;;/ One Crrewt
Each Add'l1onal Crrclllt or WIth
~ ri I)~' .iJ /\, ~/_ ServlceorFeederPemllt
OWners Name ~f~/'.Y tY >-' h6)J......V.,&r
Address52.S ~ ~ E MIScellaneous (Senile/feeder not mcluded)-E.ICh Inst.lIlahon
C~ c,l if Phone Pump or 1ffigal1on $ 55 00
\ \ SlgnJOuthne Lrghtmg $ 55 00
OWNER n.4ST ALLA nON L'IDlted EnergylResldentlal $ 28 00
The mstallatlOn 1., bemg made on property I own which Limited Energy/CommercIal $ 50 00
1<; not mtended for sale, lea<;e or n...'Ilt MlDlmum Electnc Permit inspection Fee IS $50 00 + Surchargc!l
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LOCATION OF INSTALLATION
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LEGAL DESCRIPTION
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JOB DESCRIPTION
~lLh'")0.(ffY'ue plJ1.U't1!
Permits are non-transferable and expire If work IS
not started wlthm 180 days of Issuance or If work IS
Suspended for] 80 davs
2
CONTRACTOR INSTALLATION ONLY
ElectnCdI Contractor !:r:OFTF.T.n K1.F.CTRIC co.
Address PO BOX 2765
C,ty EUGENE. 97402 Phone 686-8612
Supervisor Llcense Number
4218-S
ExprratIon Date
10-1-10
Constr Contr Number
38702
ExpiratIOn Date
12121109
Owners Signature
InspectIOn Request 726-3769
3 COMPLETE FEE SCHEDULE BELOW
A NCl\ Re\ldcntlal- Smglt.. or MultI-Farol" per duelling umt
ServIce Included
1000 sq ft or less
Each addItional 500 sq ft or
portIon thereof
$11700
$ 2100
Each Manufact'd Home or
Modular Dwelllllg ServlCC or $55 00
Feedt..>f
~ -r. I>W rpOUlreS you 10
B Sen lC""1'r~der~L Inl;t.llatlOn.\Al!er~~l'\!Jii'U8ill'fcalIon
" 'on"od by t," u ~ h
tollow iU'(JS ac, ~"11 se rules are sellorl
200 Am~6'/ijlejll;\lon Cenler 10 __ O,s,l'\<mm-001-
201 AmQI\1@illlb9iinpQ01-0g;O tI~:;:: ot:itI8U01es by
401 AmlCOOeOOYmnpgay 01 raln(~~,;" Ihe$e~one
\l,\\}{lllie cen e . "'~ft"a,tIU"
601 Amps tlilji1b:e~I'8/'the Oreaon UI~hlY ~~tl'(J()
Over 1000lJm\llWdimter IS 1-800-33'-~ 00
RecOlmect Only $ 55 00
C Temporal) Sen'lces or Feeders
InstaltffiY'.:~~~ahon or Relocahon
~~ ~1it~M!I SHALL E;~7:: :r fi@JiYCf"7h(f1;1
401 ~~d\At 1?t~~NDER Ilil PER~\\d~oNGr'
liUIVI'M: ttu OR IS AbAI~uUI~tD FOR
Over 7ffit'fBb"fJ~CjJ~ib"D" "B ' above
D BrdDch CirCUIt!,
$4800
$ 400
4
SUBTOTAL OF ABOVE
12% State Surcharge
1 0"10 Adnnmstral1ve Fee
5% Technology Fee
TOTAL
'ihared Dnve(T YBuddmg Fonn~lElectncal Permit Application 1.08 doc
Cv&I-oYlu2.f' ~~c.f J OV (,Lrvvp T &rYL-p ~ CA. U t.U- -/-V !-\-OO M~
--\-owvp Se1AJl,VC ,
225 FIfth Street
Spr~ng(;;ld, Oregon 97477
541-726-3759 Phone
~
CIty of Spnngfield OfficIal ReceIpt
Development ServIces Department
PublIc Works Department
Job/Journal Number
COM2008-00437
COM2008-00437
COM2008-00437
COM2008-00437
Payments
Type of Payment
Cred,tCard
CRCCClOt 1
RECEIPT #.
1200800000000000641
Date: 06111/2008
DescriptIOn
MmlmumlAdJustment ElectrIcal
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Admm,stratlve Fee
PaId By
ERIC SCOFIELD
Item Total
Check Number AuthorizatIOn
Received By Batch Number Number How Received
ddk
711152 In Person
Payment Total
Page I of I
3 28 IOPM
Amount Due
2100
105
252
2 10
$2667
Amount Paid
$26 67
$2667
6/1112008