HomeMy WebLinkAboutPermit Electrical 2003-09-10225 FII.-TII S:I'REET . SI,RINGF'IELD, OR()7477 . t'll:(541)726-3753 . FAX: (541)72(t-3689
IIT,ECT'RICAL I' ILRM I'T API'LICAT'I ON '2 1'neJ zonr
iollowing proiect as submitted has the following
ng and does not require specific land usea(iil1r .166 Number
I,EGAL DESCRIPTION
J0B DI]SCRIPT'ION
Datc
Pernrits are non-transferable and expire if u'ork is
not startetl within 180 days of issuance or if work is
Suspended for 180 days.
1
approva
Date
Service Included
I 000 sq. ft. or less
Each additional 500 sq. ft. or
porlion thereof
Each Manufact'd ljome or
Mtrdular Dwellirrg Setticc or
Feeder
Z 3
A.
N01
'tHl
i\dni
C
(7
s r 06.00
$ 19.00
$50.00
Y
Electrical Contractor tsr ,lckr li L ict t' rt'
Acldress lCit., /-lt( ir:d
tl.
l,'L 200 AmPs or less
201 Amps to 400 Amps
401 Amps 1o 600 Anrps
601 Anrps to 1000 Amps
Over 1000 Arrrps/Volts
Reconnect Only
Ll $ 63.00
$ 75.00
s l 25.00
$ 163.00
$375.00
$ 50.00
$ 43.00
$ 3.00
bJ o4
CD
4/
_r.l
City L Phone {'(ri gri l')
Supervisor I-icense Nunrber 3 ftr0 S C. Tenrporary Strvices or licerlcrs
toExpiration Date L/l
Colrstr. Con1r. Number 4)e u,
Expiration n"t" l.) it I - 0 3
Si f Supervising Electrician
Ou,ners Name
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Arnps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over (r00 Anrps or 1000 Volts see "B" above.
D. Branch Circuits :
Nerv Alteralion or Uxterrsion l,er Panel
One Circuit
Each Additional Circuir or with
Service or Feeder I'enrrit
E.Address
City Phone Punrp or irrigation
Sign/Outline Light
s 50.00
50.00
2s.00
45.00
* Surcharges
OWNER INSTAI,LATION
'rhelh{irilhtibilii}tE@qtrcB6fip*rtp$Wp&,il{p{+ilf
dh
is nqgll@fuil6ryadepded b,yrthe Oregon Utility
orv.pSfqgfogfpre
s are set for
)AR 952-00
f the rules i
lotification
7o/o State Surc,harge
| 0o/o Adnt in i strati ve Fee
TOTAL
)090. Y
nurnbar for the Oregon
let
'7/
rnspecrion Ret383fi t frl:ffi$-asz -234 4)
4.
Shared Dn'vc(T:/Building Fonns/Electrical Permit Application I _03.doc
l.
I
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springfield Official Receipt
Development Service5 Department
pubtic Works Department
#:
coM2003-00878
coM2003-00878
coM2003-00878
Perm ServlFdr 200 amPs or less
+ 7%o State Surcharge
+ l0Yo Administrative Fee
63.0O
4.4t
6.30rcItem Total:
TypeofPayment PaidBy
Check BUILDERS ELECTRIC
Received By
dlm
Batch Number Authorization Number
68783
How Received
In Person
Payment Total:
Amount Paid
$73.71
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