HomeMy WebLinkAboutPermit Electrical 2001-03-21, TNGFIELI,
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PERilIT APPLICATION
Ci ty Job Nurnber /
3. COHPLETE FEE SCIIEDI.'U BELOS
A Nev Residential-Single or
Hulti-Family per dvelling unit.
Service Included:
I tems Cos t
$ 8s.001000 sq.ft. or }ess
Each additional 500
sq. ft or portion
thereof
Each Hanuf'd Home. or
-Modular 'Dvelling
Service or Feeder
s 1s.00
s 40.00
Services or FeedersInstallation, Alterations
or Relocation:
225 FIFTE STREET ,..,,1112,,,eil Signature
SPRINGFIELD, OREGON 97477
INSPECf,ION REQITEST: 726-3769
0FFICE: 726-3759
TION
IJGAL DESCRIPTION
IONa€o 6€KvtCE
2. CONTRACTOR INSTALT,ATION ONLY
Electrical Contractor L.R. Brabham, Inc.
Address 68 West "Q" Street
Ci ty Springfield Phone 747-6638
Supe rvi-sor License Number
.l4735
Expiration Date r 0/01/0r
Constr Contr. Number 08699
Expiration Date 12/18/02
Sigrra of Supervising Electrician
0wners N,/Wdt rl,ban
Add ress tu"
,RA
Ci ty Phone 7% - {57 7
OVNER INSTALII\TION
The installation is being made on
property I ovn vhich is not intended
,Jo.r sale, Iease or rent.t'iiti, i! | ! i lt Iil: i
' -lr-ii iUI lj i. :i:.ii'iti,_i omefs Signature :
!.iL r 1 + ,-, - :JUir! J_rtu
lliii,j i.. .iirlir r!ilrr
DATE:
Temporary Services or Feeders
Installation, Alteration or Relocation
1. LOCATION OF//33 ni .3r
Sum
nl, nrti( perrits are non-transferabre and expire
1{ lU1" if vork is not started vithin 180 diyst \r/' of issuance or if vork is suspended for
180 days.
B
200 amps or
201 amps to
401 amps to
601 amps to
Over 1000 a
Reconnect O
less
400 amps
1000 amps
mps/voI ts
s s0.00
s 60.00
s100.00
s130.00
$300.00
s 40.00 wt
c
ee I'Bil aEfrf
D. Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit S 35.00
Each Addi tional
Circuit or vith Service
or Feeder Permit $ 2.00
E. Miscellaneous (Service/feeder not included)
200 amps"or less S
201 amis to 400 amps
-
S
over 401 to 600 amps
-
$
0ver 600 amps or 1000-GTfs s
-Each installation
Pump or irrigation
Sign/OutIine Lighting_
Limited Energy/Res
Limited EnergY/Comm
40.00
55.00
80.00
s 40.00
$ 40.00
$ 20.00
s 36.00
SUBTOTAL OF ABOVE
7 tZ State Surcharge
32 Administrative Fee
TOTAL
&u&7UUU-
RECEIVED
5 0
RECEIPT S:
ux:
TRftF{SS: 01-0fiil4?-ib
Df;T[: f'lf;F1 i1 :-il]
fit{I HE[[]:I $ 55,tt
r,Un Lil:tr 'L,i lnlrUL 'fl^fluTfR. nn/,unul liLl\, UU+
Job: 01-00209-01 Received: 3l8l11
Unit: BLDG:Address:4605 Main St
Owner: Teresa Gapfer
Fees
FEE DETAILS
Value/Quantity
FLR:
Amount Due Amount Paid
Electrica!
Branch Circuits
Branch Circuits WO Feeder or Service
Branch Circuits With Feeder or Service
SubTotal
Electric Administrative Fee
Administrative Fee - Electrical
SubTotal
Electric Surcharge
State Surcharge - Electrical
SubTotal
1.00
1.00
35.00
2.00
37.000.00
0.00
0.00
1.11
1.11
2.59
2.59
Totalfor Electrical 0.00 40.70
Plumbing
Plumbing Miscellaneous
Number of Fixtures
Minimum Permit Fee
Minimum Plumbing Permit Fee
SubTotal
Plumbing Administrative Fee
Administrative Fee - Plumbing
SubTotal
Plumbing Surcharge
State Surcharge - Plumbing
SubTotal
5.00 50.00
50.00
1.50
1.50
3.50
3.50
0.00
0.00
0.00
EIIEFMT
Totalfor Plumbi 55.00 0.00
Grand Total:
Page 1 of 1
3-&l-ct
55.00 40.70
Surcharge
Har 1S O1 1O:OOa Steve I'le I horn 541 -S98-6.+69 p."
THE N ICEWONG ER COIVI PANY
90 I wEsT EVERCREEN 8LVD, ' VANCOUVER. Wn ' 98660
(Sool 426-5e72 t 13601 6994747 . PORTI^ND 15031 285's234
FAx 13601 699-4753 . E-MAIL nice€nc@yahoD.(om
DATE:
TO:
FROM:
F€:
March 16,2001
Mom's Fast Stop
Ken Vdenti
Equipment Ordcr
We will be installing the folhwing equipment at:
Mom's Fast Stop,4605 Main Street, Springfield, Oregon 97478
. AutoFry Model MTI-10, SelFContained Fryer
. Reconditioned Warmer, 3 * 4 Tier. Star Hot Dog Machine, with Built-In Bnn W'armer, Model30BB
. Star Model 3SG-10, Sneeze Guard for Star 30BB Hot Dog Machine
. 3 Compartment Sinlq 3C17xl7 (with drainboard)
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