HomeMy WebLinkAboutPermit Electrical 2003-09-11225 FIFTH STREET . SPRINGFIELD, oR97477 r pH:(541)726-37s3 o FAX:
E L ECTIiI CAL P E RM IT AP P LI CATI O N
City Job Number fnmzco3 -0artr5ate
Zoning
Date
A
I 3.
7 tal 11
LEGAL DESCRIPTION A.
-o
$ t06.00
$ 19.00
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.IOI] DESCI(IP'TION
Permits are non-transferable and if work is
not started within 180 days of issuance or if work is
Suspended for 1E0 days.
2.
Electrical Contractor 1S
$s0.00
200 Amps or less 'l -S ur.oO
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 Amps/Volts $375.00
Reconnect Only $ 50.00
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
Installatlon, Alteratlon or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600 or 1000 Volts see'r*l-rr"
New Alteration or Extension Per panel
One Circuit
or with
Service
A8A
Limited Energy/Residential
Limited Energy/Commercial
lYo State Surcharge
l0% Administrative Fee
TOTAL
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B.
Address Po Boxl.\(z
City J. rnor," *l Ll I -22)L
Supervisor License Number Lt<qqs
Expiration Date I D -c,l-_OLl
Constr. Contr. Number 3KLl(l
Expiration Date 1- t-c/
S ignature of Supervising Electrician
C.
D.
E.
$ 50.00
s 69.00
$r00.00
$ 43.00
$ 3.00
t
Owners Name
Address
City
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Phorc Lt lT[qq],'$ffi
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for nale, lcase or rent.
Owners Signature:
Mlnlnrrrnr Etectrlc Permlt Inspectlon Fee ls $4s.00 * surcherger
$ 25.00
$ 45.00
4.
IL
LlInspection Request: 726-3769
Shared Driv{T:/Building Forms/Elcckical permit Application I {3.doc
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Q-troz
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Sign/Outline
Each
City of Springfield Official Receiut
Development Services DePartment
Public Works I)epartment..
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
#:Date: 0911112003 9:02:54AM
coM2003-0088s
coM2003-0088s
coM2003-00885
Perm Serv/Fdr 200 amps or less
+ 7%o State Surcharge
+ ljYo Administrative Fee
126.00
8.82
12.60ruItem Total:
Received By Batch Number Authorization Number How Received Amount PaidType of Payment Paid By
C&S ELECTRIC dlm 5060 In Person
Payment Total:
s147.42CheckSIfr:O,
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