HomeMy WebLinkAboutPermit Electrical 2006-08-25Crr<av-AJ ,-a
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rFAX:(541)72G368s
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A. I{erv Reridentiat - Single ar Multi_Family per dwelling unit
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
B.
6Date
3.
LECAL DESCRJPTION
JOB DESCRIPTION
ElectricalContractor L { la L
Address q 33 r\€"!A,s i?d
Phone 1 "A sqs
Supervisor License Number \ t-f q-s
Expiration Date iO -D-l
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000Amps
Over 1000 AmpsA/olts
Reconncct orrly
C. Temporary Serricer or Feeders
Installatlon, Alteratlon or Relocatlon
New Alteratlon or Extenslon Per Penet
$50.00
$ 63.00
$ 75.00
$125.00
$r63.00
$375.00
$ s0.00
$ 43.00
$ 3.00
$106.00
$ 19.00Permi$ ere non-trrnrferable end expire lf work isnot started within ltO days of lssusrcc or if work isSuspnded for 180 days.
coN?AA CrOR fiY.S?HII"A rron{ oiYl,y
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City
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Constr. Conk. Number i O 5 L{r
Expiration Date
200 Amps or less
?ll*i'to+oon*p,
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SoPo
401Ampsto6@Amps _ $100.00"**1il1ffiilfiilffifl[][ -
D. BrrurhCirruis
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OwnersName
Address
CO
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
E.
Minlmum Electrlc Permlt Inspection Fee is $45'00 + Surcharger
4, SUBTO:TALOF ABO OO
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8% State Surcharge
l0% Administrative F€€
5V" ra'v' Ftr
TOTALInepection Request 72G3769
Shand lhive(TlYBuitding Fonrs/Electricsl Pemit Application t {6'doc
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LOAATTON 0rlv,sr}ur"{ro,v
COfuIPLETF;FAEECffEDTILE, BEI,OW
2.Installation. Alteratious or Rclocatian:
OneCucutt
Each Additional Circuit or with
Service or Feeder Permit
-001-
- inh Street
rngfield, Oregon 97477
,l-726-3759 Phone
Cit,' of Springfield Official ReceiPt
D - lopment Services DePartment
Public Works DePartment
RECEIPT #: 1200600000000001335 Date:08125/2006 3:21:48PN1
Amount Due
50.00
2.50
4.00
5.00
Job/Journal Number
coM2006-01100
coM2006-01 100
coM2006-01100
coM2006-01100
Description
Temp Power 200 amps or less
+ 5% Technology Fee
+ 8% State Surcharge
+ l|Yo Administrative Fee
Item Total:$6 1.50
Payments:
Type of Payment Paid By Received By Batch Number Number How Received Amount Paid
Check RAINBOW VALLEY DESIGN DLM 5085 In Person
Payment Total:
$61 .s0
.50
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Page I of I
8/2s/2006
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