HomeMy WebLinkAboutPermit Electrical 2000-11-7
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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
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" 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:
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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..'. . '
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SIGNATURE
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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/
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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~ .
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2o~;',$2;3
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