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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.-- I.~,tj.tl~'~ 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 $50.00 + Surcharges . TUJ PERMIT SHALL EXPIRE IF THE WI4,KfSUBTOT.AUOE.'IDra~ ~ cP Owners Slgnature..S PERMIT IS Nb~~-'.-'~-~"'~*'.~ 0 l. . AUTHORIZED UNDE.R T!1.I~t'12% State Surcharge lO . '!S't COMMI:NlitU UK I;) t\Dt\lwJNED FOR 10% Administrative Fee :::>. ,U :\NY 180 DAY PERIOD. 5% Technology Fee 2. '"\S~ ~.'6q ELECTRICAL p~ .yV:'I(IJCAppN City Job Number l .~ V -{ )\ \ 0 \ Q \.V 1. IiiZ.LOeATli5N;i6F/iNsTXi!i'!Jf.jijoNfl~*l"'!i:xJ .'~'-5\'~'t\-'mu'-sf.'...~"..~0.~ LE\1m~J[~ 03wJ JOBDt-~ ~~ Permits are non-tj,;sferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. ~...eONTRA~~';;;"!'iNSTAJJi1A.~P4fioN70NiJy,rJ 2. ~"''WH'''''~,;f~'$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 ~~'-:-.-. '.{f~'.~r.~,,~;,:;;:.; )i~;'"; .'. cReceintl RECEIPT #: ~;a:Q~: ii.'-'~..' .......... IE-.,.. . . - . " _. .. , -." ..-,--.-" --,' . 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 : I' ~, .:::' , . .', ":;'.i, Lr. . .: ";~ . '. . "', . ,'.i , . ". ~-' Page I of I 11/21/2008