HomeMy WebLinkAboutPermit Electrical 2008-11-24
225 FIFnI STREET. SPRINGFIELD, OR 97477 . PH:(S41)726-3753 . FAX: (541)726-3689 .
ZON UJ Q..,
1NTI1ALS\. ~ . ..
DATE . t1.1-A,..vO.
SOURCE t.L~o.--
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Expiration Date /0- / - I (j ATTENT10N:C ;",,",IINI~/~QlRelocation . Cf)
, .Jlowruiesadopl!lJd~nUtllity ($55.00.!S\.:
N 1 ~ J 9 Notification Centera<1tl_~_lforth ,. $ 76.00 .
In UAfUJ52-o01-o04t9It~ ~.OO1.. . $110.00
Expiration Date (( .3:: - (j q 009(). You may Ob~~!J1 c . e of the ~ls see "B" above.
Signature Ofsupervi7ing EI .cian ':'~r'::,~~e;~r~."..:' .~...-.~. .~..
. J Ii Center IS 1'I~<\}r Extension Per Panel .
r:jhi. 'IJr.",---- One Circuit $ 48.00
. ,0. J L1 ~ m., J A. ./1 / Each Additional Circuit or with .
~,t1..JI./l)A(WUV.' Service or Feeder Permit . $ 4;00
:::: N~A~0 HDldJu1 ~~;i~~~t~~l~m~~f11!~ij~~w~~)~~~~!~~~.ij~!I'?n;'
. City '- ~~.1 rI. p.hone .. Pump or irrigation $ 55.00
-=r- )" . - Sign/Outline Lighting $ 55.00
OWNER INSTALLATION Liriiited EnergyIResidential $ 28.00
The insuillation is being made on property I own ",hich Limited Energy/Commercial $ 50.00
is not intendedlW{)slal~ ~?,e or rent. .. Minimum Electric Permit Inspection Fee is $50.00 + Surcharges
. TUJ PERMIT SHALL EXPIRE IF THE WI4,KfSUBTOT.AUOE.'IDra~ ~ cP
Owners Slgnature..S PERMIT IS Nb~~-'.-'~-~"'~*'.~ 0 l. .
AUTHORIZED UNDE.R T!1.I~t'12% State Surcharge lO . '!S't
COMMI:NlitU UK I;) t\Dt\lwJNED FOR 10% Administrative Fee :::>. ,U
:\NY 180 DAY PERIOD. 5% Technology Fee 2. '"\S~
~.'6q
ELECTRICAL p~ .yV:'I(IJCAppN
City Job Number l .~ V -{ )\ \ 0 \ Q \.V
1. IiiZ.LOeATli5N;i6F/iNsTXi!i'!Jf.jijoNfl~*l"'!i:xJ
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Permits are non-tj,;sferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
~...eONTRA~~';;;"!'iNSTAJJi1A.~P4fioN70NiJy,rJ
2. ~"''WH'''''~,;f~'$W,":''''''';'Wli'i'Eii'iii''O'r;C''"'''''''o'-d;Hl,"1;''''''''''''''=-..iiE'~
Electrical Contractor S7e.O[;. rlA'xL
Address
f o. Bo-,; 7-/5' {
City GoJ-
;:l ,;l,. ;. (.,f.,S
Phone
'."""') .
Supervisor License Number ..;"> c:; 11- S.' .. ~.
Constr. Contr. Number
Inspection Request: ~26-3769
Date
3. rw:e6MPLETE~ii1fuSCHEDi:JiJEiBEww~~llPqJ4'i'i!''''II!'~'';;;1
~&L.",.."_" ""~r"'N~"ry."."""",""~,..",."~,,,._._~'~_0"""~"",""',~,,,"'0,~"""""",~,",,",,_~_,dlir1lilit'1ij;Ii!llt~kJ1~imi.~<ilWllil8,.;,;"
A. r~~~t[~~lr~!~l~lf~~TQ.~~~~!yl~'~~~iijn:"gm~~!.D~l
Service Inclnded
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$117.00
$21.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$55.00
B. ~~~~~~~;:~~~~)!~~uEfi2*!~l!ti{~!~~1~I~~~l
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
.601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only .
$ 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
.~ ..
.~ . """w""",,,,,.c{c'_'."'~.''''''"''''_"~'' "_fd~C\""~
c. ..Tern ra, ;Ser:vlces,or"Feeders& ~, ,," '" " .. .., _<,' ..Jiklmq,;h~,Ij,,-:'.
iji.--...-.. p~t.,.,.._ a~'''U"'''"''_''''''"'"''''''~''_'~'"''''''~'''''''~''ill,..,,,,~f~,1.. . ,-,.""."""."""... _ ~""k if._mi~ti.{;l,w
TOTAL
. Shared Drive(T:)/Building FonnsIElectrical Permit Applica1ion l-Q8.doc
225 Fifth Strcet
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-0 1666
COM2008-0 1666
COM2008-0 1666
COM2008-0 1666
Payments,
Type of Payment
CreditCard
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cReceintl
RECEIPT #:
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City of Springfield Official Receipt
Developmcnt Services Department
Public Works Department
2200800000000001674
Date: 11/21/2008
l,26,06PM
Description
Temp Power 200 amps or less
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
STEVE HAUCK
." L,'.,-.
.,', .:.,'
:..',' "
.,.
Item Total,
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
57.00
2.85
6.84
5.70
$72.39
Amount Paid
IIh
2093c Phone
Payment Total,
$72.39
$72.39
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11/21/2008