HomeMy WebLinkAboutPermit Electrical 2008-8-21
OCT-25-2007 14 08
10/25/2007 13 07
BUILDERS ELECTRIC
7253575
CITY OF SPRINGFIELD
541 485 4055 P 01/01
PAGE 01
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. IN\Tl ALS '" \"^ j
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~ "i<l)V SOURCE '(Y\ foQ/?/
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CITY OF SPRINGFIELD, OREGON '
,
225 FIlTH ~ET . SPRlNGI1ELD, OR 91477 . PH (<4l)n6-J1S' . FAX (S41)126-:l689
ELECTRICAL PERMIT APPUCATION
CII)' Job Number .r 0"'"" zoO &' - 0 07' b
I ('-200 Amps or less S 70 00
201 Amps to 400 Amps S 83 00
I~- I J I"'
Addres. lr, vle",'''( (~ 401 Amps to 600 Amps S13800
,- A'f;EEN-TJOi'hC"0C ~ 601 Amp"O 1000 Amps Sl8000
CIty c~ ]t~( r'P Phone (Ltf~.'''''';''''''>-.:ru\ :; OvcrlOOOAmpsNolts $41300
Notlfl~at;on Camel ReconneclOnly S 55 00
-.le.QAR952.001-lL \ ~~~, __~ ~ .=-J.--'1....,,..~"I-,.T.'I"-1--.-,.1"1," .,.... ~
Supel'Vlsor License Number S2 "OOn 'Vnll may OJ C., temporary Se,:"c", ~~ Feed,en, ,- ':', ,', "
calling the centor I
/6/ -/- I $3mher lor the 0, Installadon, Altenhon or ReI....l1On
Center IS 1-biZOO Amps or J"'f
201 Amps to 400 Amps
40 I Amps 10 600 Amps
OwnmNam. f!..,J,t.lt=s. ~vt!~twt~.f.
Cre-s Le-.... +- E J\flSeell~n~tl. (~;:"'~~(.;d;;~ot l~c1od;d) -~E;~h I;91;.n;tiOD'"
J _ r - .",
City ~eA &--t;;I4It!: Phone 33 S - .ss '7 ~ orr ~ or IrrigatIon S SS 00
THIS ftiiliU\1!lilIl~!:"BXPIRE IF polE V'ORk55 00
AUTH<m!i!OO'~~I~f\'fglpERI\m ,~ ":Jr28 00
The InstallatIOn 19 betng made on propertY I own whIch COI1~M!hJIOO~~ISOI'!fJ'A'f~G ~tr 'n'-~ . S 5000
IS oollOtended for sale, lease or rent AiM,lOirliI/:mE\ectn" p'enOlI InspectIon Fee I' $50 00 + Surebar~..
4 -'~ -'< ~~1i ~'tABoVe ",. ; I 'f 0
,!ffIl!. " - "
~.State Surcl1arge I b BU
10% Adm1ll19trlllve Fee ''1
5% Tcchnology Fee "7
$177~
I ~fi?~T1QN'oFi:N:f.T~ON;: .
L{OO X"'+e"'r"".4-+........A--1 l.Ji
LEGAL DESCRIPTION
17031540 005'00
JOB DESCRIPTION
-P.4<-lLA~ 'D
Permlts.IITe non.traosferable and exptre If work IS
not started wltbln 180 days of...nance or .fwork I!
Suspended ror 180 day.
2 ~roNTi4.crOR IiiiiAiEAnONONLY
. ,~, I~ I_ I ~ ~ , - ,
Electncal Contractor D" Ie- I,? y c; E. I ;-- ( n ,(
El':ptratlon Date
Constl' ContJ' Number 4"2 C1 (r:
ExprrabOn Date /.:L - ) () - I \
Slgl1atureofS~gF
(
Address
zB'72
OWNER INSTALLATION
Owners Slgnalure
I.speehon Request 726-3769
~~'1'"
C"<>
_/ro/I\
et' .''1 1 ~
Oat.
3
cOMPiriE FEE soon viE' B'Eui,w; ., --..,; 'j ,)'; :~
, " . " ... 4... I ~:: , ~
ro. ~l~ . .. - -/.. -. --'"'~"!I'?"T__-"""''''_ ...~.:'t
A New Re.idenhal- Single or Multi:Famlly per dwenmg unJi., ',;
I I , ~,~ ..~~, ,~
SemcelneJuded
lOOOsq ft or I." SI1700
Each addItIonal 500 'q ft or
portIon tllereof $ 21 00
Each Manufact'd Home or
Modular Dwelhng Semce or
Feeder
SSS 00
-.. ~~-.....'j ~'-'f"'~-~~ "1'~"r"':-T,1"''ll'"l''r,:~r.:rr-'''''''
B ' Senlees or Feeden - Jnsfall.hOn, Alterations or Re1oeation,' "
, ~ I"" '" J. ,-" ~(
"'1'7""~I7!.Y-r.""
[1 "'V[",J
S 55 00
S 76 00
SIlO 00
Over 600 Amps or 1000 Volts.ee "B" above
~_ ,_ ~~....~ ''''~ ,;<~; .. , --r , '"'l' "~l
D Braoeh C1renlf$ ,- '^ " ',",
I - ' I
~ 1'-:
"
New AlteratIon or E~teDsl0D Per Panel
One CIJ'<:U1t I
Each AddItional Cm:ult or Wllh I Cl.
SerYlce or Feeder Pemut D
s..mm (50)
$.,A--OO"(S)
~o
'tD
TOTAL
5bved. Onvl:[T yewtdlD@:FormsfEll!CtJ'lcal Penmt ApplK2tlon 7-01 doc
TOTRL P 01
225 FIfth Street
Sprmgfleld, Oregon 97477
541-726-3759 Phone
CIty of SprIngfield Official ReceIpt
Deyelopment Services Department
PublIc Works Department
Job/Journal Number
COM2008-00716
COM2008-00716
COM2008-00716
COM2008-007l6
COM2008-007l6
Payments
Type of Payment
Check
\..
LRcLemtl
RECEIPT #,
2200800000000001272
Date. 08/21/2008
Description
Add, Alter, Extend CIfC
Add, Alter, Extend CIfC Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Admmlstl alive Fee
PaId By
BUILDERS ELECTRIC
Item Total
Check Number AuthorizatIOn
Received By Batch Number Number How Received
nJm 97902 In Person
Payment Total
Pa2e I of I
95957AM
Amount Due
5000
9000
700
1680
1400
$177 80
Amount Paid
$177 80
$177 80
8/21/2008