HomeMy WebLinkAboutPermit Electrical 2004-02-09225 FIFTII STREET . SPRTNGFIELD, OR97477 o PH:(541)726-3753 o FAX:T$.+tCflSUi35ggoject as submitted has the lollowing
ioning, and does not require specific land use
E LECT RI CAL P ERM IT AP P LI CATI A N
City Job Number Date
1 3.
LEGAL DESCRIPTION l'7 ,'3s-' oo ' oo9o>
D A
JOB
Service Included
1000 sq. ft. or less $106.00
Each additional 500 sq. ft. or
portion thereof $ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
Z a
D.
approval.
Zonlng
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
COiyIRA C T O R I N STAL IAT I O N
Electrical Contractor N
Address &,*(rr''ST
Phone 7qf -gi/6
Supervisor License Number
Expiration Date /D'Dt-D4
Constr. Contr.Number / 5 L L/eq
Expiration Date t
Signature of Supervising Electrician
/') /l /L-
o
Owners Name
Address
3qs+ s C. Temporar,v Sert'ices or Feeders
B. Services or Feeders - Installation, Alterations or Relocation:
f $ 63.00 b 0<
$ 7s.00
$12s.00
s 163.00
$375.00
s s0.00
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 or 1000 Volts see "B" above.
$50.00
7
IL 200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
Each Additional Circuit or with
Service or Feeder Permit
Pump or irrigation
Sigr/Outline Lighting
Limited Energy/Residential
City
New Alteration or Extension Per Panel
one circuit $ 43'oo
City
OWNER INSTALLATION
The installation is beins made on DropeIty I own which
ATri[ENtrl@Nrp mOfo JAW'rg!1p i re S y o u t u
follow rules adopted by the Oregon Utility
{dnotti6ig@erser. Those rules are set for
n OAR 952-OO1-0010 through OAR 952-0C
ies of the rules
Ph"," 72b.-'37t3
f $ 3.oo
E. N'Iiscellaneous (Service/feeder not included) -E:rch lnstallation
Limited F-{++tlA/
$ s0.00
$ 50.00
$ 2s.00
d#[00
MininThit6ffi&d&t0 f$m $$urcharges
OO
s,46
10% Administrative Fee 7,@
TOTAL
64
calling the center. (Note: the telephone
'rHI[ P.f{,L:[l!fi ,R{ "?9s$ #ili'}]: :l'l'
.,'' "'
4.
Shared Drive(T:)/Building Forrns/Electrical Pennit Application I-03'doc
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Residential - Single or Plulti-Farnily
Pmou.
? /,'h
225'Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
fL City of Springfield Oiiicial Receipt
Development Services Department
Public Works I)epartment
coM2003-01280
coM2003-01280
coM2003-01280
coM2003-01280
+ lUYo Administrative Fee
Perm Servffdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 1Yo State Surcharge
Item Total:39-Iet26
7.80
63.00
15.00
5.46
Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid
Cash BIG C ELECTRIC dlm In Person
Payment Total:
s91.26
$9t26
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