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HomeMy WebLinkAboutPermit Electrical 2005-2-18 / , ' , 0 CITY OF Sl~.mGFIELD, OREGON (> . / SPRINGFIELD ~e 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726_36~0,,-,-? '01< ~,' . ........ ~ 0':., 'WZJ.Y' ELECTRICAL PERMIT APPLICATION ' 0., 0".,;.,., 1> ' City Job Number CDtM ZOO L/ .:: _ 0/0 '2, '7 Date~"?j z - a. ~&,,%: I ~ % ~~ t().,. 0,.. If' 1. LOCA110N OF INSTALLATION 3. COMPLETE FEE SCHEuf:J. OW ~"~"6 C I ~., P~;'~1: 710 J1JCfCc:n 7.-1e::: rc=s 1 DfL .,-'G-~~ ~ \ e ~:o-1 LEGAL DESCRIPTION A. New Residential- Single or J\1Ulti~m' dwel~.!!,nit. 170<., z 3l../ ZOO 7 () 0 Service Included " ~.,::~", U'(5) ~ JOB DESCRIPTION Pt-o-v"'S C,.4J,!e- 1000 sq, ft, or less >f 6.0 "?' '" I ' / Each additional 500 sq. ft, or - ~ '\' LoW ~OITA;p AlAblO " .s.t-u..'-I2-'~ portIOn thereof $ ,0 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 ' Suspended for 180 days. Feeder 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor jhJ~:L 'l"-L\,,~~I~,es. Address -;),</'1 rJo.; <,~:.I-'., \'<Ivd City 'f".1bO...,fl...... , V Phone e'" (;',l{4 -~ I I ~ Supervisor License Number ~~:<'L(A Expiration Dale 10/01 InS Constr, Contr. Number i (0/4 S X" Expiration Date q 1/ (P.l () (p Signature of Supervising Eleclrician (~,.'::,iV ~ ' Owners Name \2~\ 6", C l A-s e Address 7/ D ;I/L Ic~,,~ L.rc-,,-t- City So ~ \"'-h Phone OWNER INST ALLA nON The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 $50.00 B. Services or Feeders - Installation, Alterations or Relocation: 200 Amps or less $ 63,00 201 Amps 10 400 ~ lequlres.YOU,~~., $ 75.00 AnmUIJ..~~1fc66fe'&Wlne Olegon v~ri~rth $125,00 IO\~C6O'II~\\iSi~?1i>~p~ rules a; :~2 ont..$163,OO Notl~q'3q ~_ ~O~gh ~~.;. :-l'oa. byS375.00 in ORg,~c tail' COpIes 0 . ~G"9 $ 50,00 0090. '(ou ma 'Note: the \el~pl. .1..... a:ai~~l\?~;~~el'o'J~~lca""" numberr.~~ter is ,:.so()-332- . Instalhi'tlOn, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps $ 50,00 $ 69.00 $100,00 Over 600 Amps or,1000 Volts,..,e "B" above, D. : Branch Circuits New Alteration or Extension Per Panel One Circuit $ 43.00 Ea9\1,AQditional Circuit or with l: \1' 1\-1\: WORK SllNi!J'tlheeder~il \:';\P\R", ,~$.,3fO lHIS PEK\\!\l1 ..", o'ER 1\-11S p\:HM~1 I,) I~IJ E. F>.'W"mll~r\l&.u ~~r.'lieel,(te,l!~'.:'~t\ii1~,li~Ja) -Each Installation NlM\:NeE(fun hJ, " pU~~'?riUik.lli~~ p\:RIOD. $ 50.00 Sign/Outline Lighting $ 50.00 Limited EnergylResidential ( $ 25,00 Z \' Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is ~ + Surcharges 4. ' SUBTOTAL OF ABOVE Lf< S/.l L( .>0 ~Z~) L, 7% State Surcharge 10% Administrative Fee TOTAL Shared Drivc(T:)/Building Forms/Electrical Permit Application 1-03.doc 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . .~ ~: Jiilty of Springfield Official Receipt Wvelopment Services Department Public Works Department Job/Journal Number COM2004-0 I 027 COM2004-0 1027 COM2004-0 1027 COM2004-0 I 027 Payments: Type or Payment CreditCard 2/812005 RECEIPT #: 1200500000000000168 Date: 02/08/2005 Description + 7% State Surcharge + 10% Administrative Fee Low Voltage - Residential Minimum/Adjustment Electrical Paid By DEVLOGlC TECHNOLOGIES Item Total: l:heck Number Authorization Received By Batch Number Number How Received djb 093296 In Person Payment Total: Page 1 of! 9:25:26AM Amount Due 3.15 4.50 25.00 20.00 $52.65 Amount Paid $52.65 $52.65