HomeMy WebLinkAboutPermit Electrical 2005-3-8
~.
( . " w ~ . ,
'" '. " CITY OF ~....UNGFIELD, OREGON ("~ ,
, '" ".'
s~P~;::y
,'- .... " ,:,..
":"". -~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX:,(?4I)726-3689
ELECTRICAL PERMIT APPLICATION S.2~Cl;o",,? '
City Job Number ~'200L\-- 0\0'2-'/ Date i",", O~"\Z;OI<,~ '
1. 'i:oEAtidNOEINST.JLiA.:iId& ,"'J,,,:j 3. I::COMPlEiE'n'Sl"Eijh'...~-..Ow."'':. '~~"',~',,'" '\
tE. " ""L., '.' "" "<' -, v,' .~",'.~.. ..,'~ ,'tgJ., -"',~'-'~!,"'" " .
"7 !iI..r; (!~ f C, '& I'r"
, / f? (l EKI)::I ~ E> 7 ,v,cLj7 '7F~"7""'1\"'F.s~?"",,~-~ . ~&:;'?"'I.1"-""t-"~~",,,,,,~-]
LEGAL DESCRIPTION I A. Hif>i: I{~i<!eri!i.*l T.'~ligle~:': ,,~ " .. rl)P~p:~,v~lli.n.il,~ili~ " .
~''''- -\j' -- --~Q;~~.
\ r 0.3 2-~ Lf '2 OD7@ServiceIncluded """- ~ ~."O "'& '~
JOB DESCRIPTION 1000 sq. ft. or less ,"""-~~IS}. $106.00
!/, Each additional 500 sq. ft. or ~ "-
Permits are non-transferable and expire If work is Each Manufact'd Home or
;. not started within 180 days of issuance or if work is Modular Dwelling Service or $50.00 ,"
Suspended for 180 days. , feedeATTENTION: Oregon law requlI"" yv<l to . ,
2. f'CQ,N.tjt4cto~\PV#@PQN9~Y'1 B. !4S~~t\:~~t~~~~~li~~t~1~~~~WN.~m,~~'oc.Jl~n:' ,I
Electrical Contractor, (I t![)(/ rj(1f- rt. ~ 200I\\&MIb~OOl-0010 through OAR 9~:?6r8d'
20 llAQAA ttG/M%Y,~btain copi,,~ vi ,l;:~ p$'ii.~oV ,
If~/Y( t AIli~IPna08~nter, (Note. ",~ ,~,~':>\I0\l"
401 ml'~~e~ lor th~SOregon U[::::, ~:::'~i~J3~iqO
d c",r-"7 '7//,r 601 Amps to 1~91&P!1;"1-800,32'),,)"dd\ $163.00
() (7 /'-7;7? Over 1000 Amps/Volts $375.00
Reconnect Only $ 50.00
Address
{l.o,
City
(!.L1./:::.<; cz:d ~t l- Phone
() .Jv1 -
Supervisor License Number
Expiration Date
Constr, Contr. Number (, ij Cf l'tJ
,</_(C_ OL"'-
Expiration Date r 17 /'
Signature of Supervising Electrician
ft Afce O~
Owners Name ,/ IIIII'1 (ill /1-- >" E
(
Address
City
Phone
OWNER INSTALLATION
The installation is being made on ~.v~-../ I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
c. f ...Timp:;'rifyS~rVices' ~i"Fg;,deis":
,,,
, \'
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
40 I Amps to 600 Amps $100.00
~. :..Qv;e~~ ~mp,~ ~r Ift~O V~lts ~ee "B" a~ve. , .
R-iI~~r&~~~~!;9j~ !.J;'/:Pitiflf J'm: v~lGHi\', ",
ALN' ~"'t~rrt''''ln('Er TUI~ DCpQ~p^IT IS, NU'
ew',tU era Ion orw Itenslon er ane
ClOIie;<;:frCuitD OR IS ABANDONED ~UR $ 43.00
At~~c~:M<!iP!!i1iicem;uit or with
Service or feeder Permit $ 3.00
" ,I
-,
E. [~i~II,a~~~'Us '(S~91~e/J~~d,er,1i:ot ~~i~ded)"Ea~h )n'~i~llaii.iJld
Pump or irrigation. $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential'X $ 25.00
Limited Energy/Commercial C $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
t -," '.. ".. . J
4. IsWf:.oTAL'CiF'AiiOVE: \,',; '" ':', ".'" ,'.
~'..,".' - ~ ".- ." '0' ",.'4 ,,,,'f ........ .;, .:.'.' ....
L-IS, 00
3,IS
y\l)
S::J.IoS
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drivc(T:)lBuilding FonnslElccbical Pennit Application I-oJ.doc
225 Fifth Street.
. Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-0 I 027
COM2004-0 I 027
COM2004-0 1 027
COM2004-0 I 027
Payments:
Type of Payment
Check
3/1/2005
.
RECEIPT #:
....~_.....
Wi"'........~,..~-." "'".''' , '..
.;, .... j
t "
---.. ;
, ,
i "
. . .~, it ..
Jli..ty of Springfield Official Receipt
.velopment Services Department
Public Works Department
1200500000000000270
Date: 03/01/2005
Description
Low Voltage - Residential
MinimwnlAdjustment Electrical
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
BRYCE OLSEN
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
ddk 2810 In Person
Payment Total:
Page 1 of!
1l:00:36AM
Amount Due
25.00
20.00
3.15
4.50
$52.65
Amount Paid
$52,65
S52.65