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HomeMy WebLinkAboutPermit Electrical 2000-11-7 -. - 881 001 . .00 CHANGE:$ 0.50 CASHIER:001 BACKFLOV PREVENTIO~ DEVICE PERMIT APPLICATION CITY OF SPRINGFIELD BUILDING SAFETy'DIVISION 225, FIFTH STREET SPRINGFIELD OR 97477 OFFICE: 726-3759 INSPECTION LINE: 726-3769 ~ -------------------------------------------------------------------------------- . '-75 7~ /~?C_~bt:_. Ua;.~ OJ< " ASSESSORS MAP 1I: /103 "d-i 4-3 ' ,'.' . TAX LOT 1I: OS7crv, ,',_.\ OVNER: ' ,4~ D (frrJsw +- J)r(-bauaMd:n'..,'I.:I.~','", ADDRESS:",j(j..66 ~ ~ : '.C~r. 'Air SHAll EXPIRE If- I Ml: VN' ".'. 012- CITY: li'6{X~__".~"c:o,r.ITI~NOI STAT~:, Au:HOR!:...:U UI~u<:'~~;~~ONED FOR BACKFL6i1~'PERH'i~E~~~i\,oo' + 1. 05 (STATE SURCHARGE) + $.45 (ADMIN. FEE) = $16. 50 ~ lbO 0",'11-'<:.,.1'-' . ) CONTRA;;~R: _.Ct ~ 4 e, /~..i..(;~ 4-D/~.j:i.;-, .Z e. ADDRESS: Po. 7'9"'</( PHONE 1I: ,.-- ~ OVV' _ ZJ CONSTRUCTION CONTRACTORS REGISTRATION 1I: JOB LOCATION: t1....s. . .:. PHONE 1I: ,...... ... .....+1"'" .J-"'U~ ZIP: q7~O~ CITY: STATE: 6;e. /.;1/70,?,ei',t;?3;J ZIP: c;>z?~s:- EXPIRES: crs/..s/42 BY SIGNING THIS PERMIT/APPLICATION, I AGREE TO CALL FOR AN INSPECTION ONCE THE BACKFLOV PREVENTION DEVICE HAS BEEN INSTALLED AND IS VISIBLE FOR INSPECTION (726-3769). I ALSO STATE THAT ALL INFORMATION ON THIS PERMIT/APPLICATION IS CORRECT..'. . ' ~jJulv -,=- I ~~~ 01 SIGNATURE '. ~~- FOR OFFICE USE ----------------------------------~--------------------------------------------- DATE OF APPLICATION: D4.-- iYj - 0/ .ff.3 ,<- J 4 WI RECEIPT 1I: /705 ~ tf.3 ISSUED BY: J7. TOTAL AIl0UNT COLLECTED: ) (p , s-V JOB 11: rn (1.('/16-cPO 00 0/.J.9 0/ -------------------------------------------------------------------------------- ~. approval. /) . 1>>/'-'" ZOning i/- '7 - ,r-D 1<,,,) Date Authorized Signature 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OF INSTALLATIONQ JLtI /'J:rk'j/J3'; ('ru~, r. LEGAL DESCRIPTION /70~ Z 3L.i3, <"!>s->'ClC') . JOB DESCRIPTION 1;,"'--//11 1'>>1'/'1'( - Vt'lA/il1( f,/,)b /U. Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. .' ; ELECTRICAL PERMIT APPLICATION , , . City J~b Number 00 ~' 6/63 j- 0 ( COMPLETE FEE SCHEDULE BELOV ~ New Residential-Single or Multi-Family per dwelling unit: Service Included: . Items' Cost' Sum 3. A. 1000 sq. ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home, or Modular 'Dwelling Service or Feeder .$ 40.00 ,B. Services or Feeders /. _ Installation, Alterations ~ ~~r~nlcqOr Relocation: 2. CONTRACTOR INSTALLATION ONLY Electrical contractorOit/Ufi7#"",- Address P p. I3nJ< <ltJ"l</K Ci ty ?; '.19 ' o~ Phone'i <11- </'8"'-1- 9C;t g" Supervisor License Number .33QI JL E Expiration Date /tfJf)</ Constr Contr. Number 1'-I'-I1;'i55 ~O;1;?:"~ (dI Owners Name -411K'/",,,,,y.-O/((I'/l/J/llf Add ress ---,-C) '5:f /l;ar dL", A 1// . City r~nq//l1 Phone ')<11- <j/?</.dt:Ji'O OVNER INSTALLATION The installation is being made on property I ,own ",hich is not intended for sale, lease or rent. Owners Signature: --------------------------------------- DATE: IJ{')'7Ci= RECEIPT I: RECEIVED BY: '1"'1 f'( 572::-"', 200 amps or less 201 amps to 400 amps 401 amps to 600 amps 601 amps to' 1000 amps Over 1000 amps/volts ----- Reconnect Only $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps' 'or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits $ 40.00 $ 55.00 $ 80.00 see "B" above " New, Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit E. Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res ~ Limited Energy/Comm 5. SUBTOTAL OF ABOVE 7% State Surcharge 3% Administrative Fee TOTAL $ 35.00 $ 2.00 not included) $ 40.00 $ 40.~ -='- $ 20.00'~.@ $ 36.ql'JliT1~ . ('")u# C") t::::l::z .. 2o~;',$2;3 / .~~ ~n'-6 .~~,,-..J8 2.2.. .~~ '" ~ ~ 0' rT1 0 0 t'J ......... ooc..n