HomeMy WebLinkAboutPermit Electrical 2004-02-10submittod has the following
specific land use
225 FIFTH STREET o SPRINGFIELD, OR97477 . PH:(541)726-3753 .
E LE CTRI CAL P ERMTT AP P LI CATI ON
City Job Number Date Z
3.
A
t-L
LEGAL DESCRIPTION
JOB DESCRIPTION
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1
Electrical Contractor
Address
Owners Name
Zoning
Oate
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
-tj-o
a
A.
$106.00
$ 19.00
$50.00
B.
O 200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
5 Or". 1000 AmpsA/olts
Reconnect Only
D.
(-'$ 63.00
$ 75.00
s125.00
$r63.00
$375.00
$ s0.00
$ 43.00
$ 3.00
A,,N
Cify Ph""" 5f I d286 z?&
Supervisor License Number Se,ya s C.
Expiration Date
Constr. Contr. Number 5/O83
Expiration Date /, -d7-D 5
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.
Address
City Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
E.
Pump or irrigation $ s0.00
Sign/Outline Lighting $ s0.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 * Surcharges
N
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Pennit
7% State Surcharge
l0% Administrative Fee
TOTAL
//
7l
Inspection Request: 126'37 69
4
Shared Drive(T:/Building Forms/Electrical Permit Application I -03 'doc
1.
/1oq z4 y's oa?o-r
/n 4 /-fi (/
f r,rf 'o
225 Fifth Street "'
Springfieid, Oregon 97 47 7
541-726-3759 Phone
Ci"y of Springfield Official Receipt
Development Services Department
Public Works Department
Date:
coM2004-00159
coM2004-001s9
coM2004-00159
Perm Serv/Fdr 200 amPs or
+ 7o/o State Surcharge
+ l0o/o Administrative Fee
less 63.00
4.41
6.30
Item Total:$73.71
Received By Batch Number Authorization Number How Received Amount PaidType of Peyment Paid BY
CreditCard NEW WAY ELECTRIC dlm 000296 012010 In Person
Payment Total:
$73.71
$73.71