HomeMy WebLinkAboutPermit Electrical 2008-10-10
Date
ZON C-c,;
INITIALS N y~ ~
DATE in-IcY ~
SOURCE\'C"..'rs~ ./
10/ /O/f) v-
I \
,.
225 FIFI1I STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753, . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION '
City Job Number en P11 :J n () 0 (J (6? If.
, - .
200 AJnps orless,
, 20 I Amps to 400 Amps
'(j?vst~~~~.tp /iPIPI,iliiJTh
..~~n.'~ ^.., lot Jaqwnu
uO'tB~"!'\'~N J6Q]0\ilips'lo-1000 AlnI1S Iln:)
. , O\~. ,\ 'jAlL18"l alll UUI 0
8110l.!'J8iOl 80ver 1000 I\JllpSi'Y,oltso. I "0600 $426.00
. - ....:.:!I--i{"\:) 11I'P'OI:l AOI..d II ^
Aq 501"J a'h j"R~c~nnect OiilX '00-GS6 \:J'liO u! $ 57.00
'00' ~c')' "''''or) 4""OJ41 0 ~L1u , .
-, v."w'- ~IlBOIIIIO
41J0118S OIPCS2~~S-~::~~,:!j{' - w'_,;;i':;;:"'"'~-' '-C"'_i'_-!""" ," l1li% m
. racm Clime! e rs~ &~""fi""" ,k~ ,,=" u ,''''
~'''''n uo5",O' ,,' ~~.....~, mg.
~';'~oA SOJ!l1beJ MBI u05oJO :NOI1N311\f
Installation, Alteration or Relocation
200 Amps or less
20] Amps to 400 Amps
, 40] Amps to'600 Amps
1. li,';Vf!'i'(Jei:ijii(jNt(jE'lfNS~(jN!IIIJJ;~~1l
~",'u@i;q!iM'l1rnwll'''''''",'''A'",'"'',"''''''''',*V<'''__
97rJ S. -=5 7 /71 7>/0 ~.,-
LEGAL DESCRIPTION:
/~(j:2- () c; I ,-:5
JOB DESCRIPTION:
/~c')O
AD!) .J- i-/ KL Tn [;)(1 S 17lfV'r
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
1'~eoi\lrFEe1foRliNsT~mHQ\X~lTi~E~
2 """~'"''~'~'''''''''';';'''""",0imiciiiJ,~~'';'"'''''i'<'''i''''''''i~'''''""I" """"--""t'..~-"."~",.",."",,,
. ,"~_"_,-,"","" ,."u",,",,,,,,.~~,,. .~~~.-,_ ... "'''''''_'''..' ..". ..H .. .- ~ ''-'" ~".~~~ ."' _...
Electrica] Contractor /JW/v,=~ ' .'
f
Address
City
Expiration Date
e of Supervising Electrician
r
Owners Name
rl1ar-1-IA' 7<rnu.N\
OS, /:3 77J, "PI:)(". f?
Phone 7'1/-/5'79
Address q 7 cJ.
City c5 P{T)
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signahe: J!.
(11/>f; 7' ~ ,
"1-
Inspection Request: 726-3769
3.
A. ,~~lia~*:lml_~grsriigm?J\~Mmti;El::nl~~a~1;uifgEf~m4iu
.,... .:' "z""'''''"'''-'' "",-",_ m";)b..-></Oi,;.;..-c",,,_~~;....__,,,,,J;__~,,= ,'" ,," ,'..... ".,.. -'
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
I'Om,qllortion thereof
Each Manufact'd}lome or
Modular Dwe]ling Service or
Feeder
,$121.00
$ 22.00
. $57.00
B.
$ 73.00
$ 86.00
$]43.00
$] 86.00
$ 57.00
$ 79.00
$]]4.00
.~
Over 600 Amps or 1000 Volts see "B" above.
lliM~_"'t- """"'''''''Wj''_lllll-_-E ._.st .aiEl!illliill:__1iI
D. !i'~~I!~hl(B!I~Il!mr,~l:!'f~~~~_M~16ll1!i!:.ilI~~'!ik""J!&l.
, N~wl\i~_ ~ft,S~iI:!i!1VmFl\\1l!il::J
l:!BHI\I 1fF'/~' S~1:i IHONn Q3ZI80HlnV $ 50.00
ION ~aeIl \.'ailJ iI:t'I~~wj,W>l83d 5tHl )k
)ll:!OM;.3-W:dIr P<!rIrl'iI'- '3;J'l00 $ .
. . I "
(" :!:S2-
E. }j~1~11i~~iiF~j~j~~~Mi:li~~dlw~~im~iftion'
Illit0fu~L"""-W'0"""'OO"$""1l&WdJ..i<Ww0&,j;Hi4~-R'",?__*"i;,)/",;w"7"""~"'"_"'~ .). li -- " ~
Pump or iirigation $ 57.00
, Sign/Outline Lighting $ 57.00
Limited Energy/Residential $ 29.00
Limited Energy/Commercia] $ 52.00
Minimum Electric Permit Inspection Fee is $52.00 + Surcharges
4. tJ~
]2% State Surcharge
1'0% Administrative Fee'
5% Techno]ogy Fee
,7)
.,~O
, 'W
TOTAL !!i? ~
Shared Drive(T:)fBuilding FormslElectrica1 Pennit Application 7-oS.doc
;4:DD tV -bl<, (')ft.V fh7LPLf(~
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-01664
COM2006-0 1664
COM2006-0 1664
COM2006-0] 664
Payments:
Type of Payment
Cash
,
cReceintl
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
1200800000000001056
Date: 10/10/2008
1I:07:26AM
Description
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Amount Due
600
0,30
0,72
0.60
$7.62
Paid By
MARTY BROWN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
cjc
In Person
Payment Total:
$7,62
$7.62
Page I of I
1011 0/2008