HomeMy WebLinkAboutPermit Electrical 2003-09-09225 FIFTH STREET . SPRINGFIELD, ORg:-477 r pH:(541)726-3753 r F
E LE CTRI CAL P E RM IT AP P LI CATI O N
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LECAL DESCRIPTI
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work ls
Suspended for 180 days.
2.
Elechical Contractor
Fo
City J- rnon" -l Ll I -2zal-
Supervisor License Number qqs
Expiration Date I D -ol-cLl
Constr. Contr. Number 5KLl,l
Expiration Date (i - t
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 or 1000 Volts see 'ts" ubo*.
Nerv Alteration or Extension per panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
the tollowing
land use
oLP r?-
t -a3
$ r06.00
$ 19.00
,/ $ 63.00 AS oe
$ 75.00
$125.00
$ 163.00
$37s.00
$ 50.00
$ 50.00
$ 69.00
$ 100.00
$ 43.00
$ 3.00
Zoning
3.
Address Ror l'\(z
Cq
A.
B.
C.
D.
Servlce Inclurled
l(X)0 sq, fi, or lenr
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsAr'olts
Reconnect Only
Signature of Supervising Electrician
Owners Name
Address
City
E.
Ph,"" 47-4:5;7
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, Iease or rent.
Owners Signature:
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ s0.00
$ s0.00
$ 25.00
$ 4s.00
4.
Minimum Electric Permit Inspection Fee is $45.00 * Surcharges
lYo State Surcharge
l0% Administrative Fee
TOTAL
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G?o
7/Inspection Request: 726-3769
Shared Driv(T:/Building Forms/Electrical permit Application l{3.doc
approval
il
$s0.00
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springrield Official Receipt
Development Services Department
Public Works Department
Receipt #: 1200200000000002092 Date: 0911012003 9:57:0OAM
coM2003-00874
coM2003-00874
coM2003-00874
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ l0%o Administrative Fee
ltem Total:$73.71
63.00
4.41
6.30
Payments:
Type ofPayment Paid By Received By
ef,eckTlumber
Batch Number Authorization Number How Received Amount Paid
Check C & S ELECTRIC dlm 5058 In Person
Payment Total:
$73.7r
$73.71