HomeMy WebLinkAboutPermit Electrical 2005-2-18
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, 0 CITY OF Sl~.mGFIELD, OREGON (>
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SPRINGFIELD
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726_36~0,,-,-? '01< ~,'
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ELECTRICAL PERMIT APPLICATION ' 0., 0".,;.,., 1> '
City Job Number CDtM ZOO L/ .:: _ 0/0 '2, '7 Date~"?j z - a. ~&,,%:
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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
.
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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