HomeMy WebLinkAboutPermit Electrical 2003-03-03225F'IFTHSTREET . SPRTNGFIELD,oR 97477 o pH:(9r)7263753 r
EIECTRICAL PERMIT APPLICATTON
citylobNumber C Z^ ltj: 6:/Z? Date
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as submitted has the tollowing
nol require specilic land use
approval t-?(Zoning -5-- oD7
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3.
A-
K
C.
D.
Minimum
IfiGAL DESCRIPTION
L Oo o
JOB DESCRIMON
Permits are non-transferable end upire if work is
notstarted rvithin 1E0 days of i$urnce or if work is
Suspended for 1t0 days.
2.
Electrical Contractor
Address
Service Included
1000 sq. ft orless
Each additional 500 sq. ft or
portion ftereof
EachManufact'd Homs or
Modular Dwclling Service or
Feeder
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601Ampe to 1000Amps
Over l0@Amp/Volts
Rsconnect Only
Installetion, Atteration or Relocrtion
200 Amps or less
20I Amps to400Amps
lCIl Amps to 600 Amps
Over 600 or loo0 Vole see'Fil"
$106.00
$ 19.00
f50-00
B.
City <F. (f Phone ttlC--CrO(
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
$ 50.00
$ 69.00
sr00.00
Supervisor License Number
Expiration Date I
Const Conk Number
0
x
Electriciaa
m n2;L
Phone
PERIOD.
7?&3769
LNew Alterafion or Extension per
One Circuit
Each Additional Circuit or with
Service or Feeder Pcrmit
low ru
Limited
s 43.00
$ 3.00
Ll
Owaers Name
Address
City
THI
OWNER INSTALLATION
The iastallation is being made on property I swtr which
is not intended for salq lease or rcnL
o"Sg IffiIt*,,
S PLrrlvitt
UNDER THIS
SHALL EXPI RE IF THE WORK
lHORIZED
COM
,"#a[1 180 DAY
Rcquest:
7% State Surcharge
I 07o Adnrinistrativc Feo
TOTAL G
PERMII IS NOT
4.
F'ee is $45.00 * Surcharges
UJ
n3qu
AG\e ?\erlrk
$ 4s.00
Ll€-
3/3/2003
2:41:43PM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
Receipt #: 2200200000000000550
Date:03/03/2003
Line ltems:
Job/Journal Number Description Amount Paid
coM2003-00129
coM2003-00129
coM2003-00r29
coM2003-00129
Add, Alter, Extend Circ
Minimum/Adj ustment Electrical
+ 7o/o State Surcharge
+ l0o/o Administrative Fee
Payments:
43.00
2.00
3.15
4.50
Line Item Total:$52.6s
Type ofPayment Paid By Received By Check Number Confirm No How Received Amount Paid
Check ABLE ELECTRIC dlm 3437 In Person 52.65
Total:$s2.6s
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