HomeMy WebLinkAboutPermit Electrical 2004-3-4
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 'iPfl1'~4$.41)726-3689 . '
ELECTRICAL PERMIT APPLICATION Zoning e<!...- . .
CityJobNumber Cd#~-tJtJ/~ Date -j/~~~::. _' . --.;- ~-():kJ
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LEGAL DESCRIPTION
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Permits are non-transferable and expire two
not started within 180 days of issuance or if work is
Suspended for 180 days.
Expiration Date I () ~I/ / V c/
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Constr, Contr. Number ... c::; / 0 cP J>
Expiration Date t, - d 7 -j) 5
ozupe~' gE trici
/ /"' New Alteration or Extension Per Panel
'/; . ~..;,~/ One Circuit L- $ 43.00 4- ~
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Address ~ 7 ~ ,.. E.1Y1~ella!lj~l!s:~~r~\',~f~,,~ert~~t:~'!s}(i'!~,d);;:-'ENai!>'!i!st!U~~!jfil
City -:J~-"v.#?I?;fj Phone
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Ele~;li~~;~;~~~~E,e~ ' ~~J:g~:g:~n Utilityc...
Ad~$~caYcJ/9(0I.ft?~, -= no~tp...&;6'det for'
n OA!:'l952.001-00 0 through OAR 952-00
CitY'H?',. '( ,. ~iljreainph'Ob'~e~Y.7$J?~W.:%S
calling ,1e cemer. (Note: (IlEi lelepllone
number for the Oregon Utility Notification
Supervisor Li2eitS; NJmtiefn~~~;Pdt'.S
OWNER INSTALLATION
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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A. ~'~~~t:Ri~i~.iHii~t~~!f~f~gl~,Qr ;.*i!),~~[~,~~i1y'~~~~C~,~~!tif:ll ~!'f:::;~
Service Included
1000 sq. ft. or less
Each additional 500 sq, ft. or
portion thereof
$!06::M
$19.~
$50.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
B. ~er..~t~~'s-.'6~~E~~d~~~;';li~i~ll~trHln)\Ait~iiti~ ~~1i~(ic1~tiiln:~t,:~!!
S..._,~}..'!~. -".." .,..~.,,'::<;". "..~ "-~,\..)-.";~'.' ,': -,~.:'_.'.'.:..",..'.'> ::-.;;;'-1">:. ,,;.;':';( ., ,. .l<-:"":"_.....r.- I
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to I 000 Amps
Over 1000 AmpsN olts
Reconnect Only
NOTI~f'
C ~"..... '.;.::..'...'\.~ ~''-'~-';'^':tt.<;':l~' ft"-i.t<..-~":(;?;;;:.<:;y< )~;:-;....!t"::~ .:;.:"'~Vi:;;, ':";"'ij
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AUTHORIZED UNDFR T ~VUH,I\
~tallationftJ~atiqnl.Hk~lgJiffi~1IT IS NU f
MJ~~~:{9~If'JSE~:gD tJANDONEO fOA $ 50.00
201 Amps to 400 Amps' $ 69.00
40 I Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
rif'~.r,<,'e~.,.,q,. ill -'>f".:'4-. 1.-"'i\."':".""V1FiXt..,..,t'~f"',... ~"t~".."",,:+~. ",,.,~.<) '..rifj'
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Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50,00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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f" ''f$t~ ~1 /. /
6!?
q',o
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-/Dr;.. .., L
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FonnslElectrical Permit Application 1..o3.doc
2:':5 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00130
COM2004-00130
COM2004-00130
COM2004-00130
Payments:
Type of Payment
CreditCard
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Receipt #: 1200400000000000267
Description
Add, Alter, Extend Cire
Add, Alter, Extend Cire Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
njrn
Check Number
Batch Number Authorization Number
Paid By
NEW WAY ELECTRIC
000312 031332
City of Springfield Official Receipt
Development Services Department~
Public Works Department
. l'
Date: 03/03/2004 9:30:35AM
Amount Paid
Item Total:
43,00
48.00
6.37
9.10
$106.47
Hnw Received
In Person
Payment Total:
Amount Paid
$106.47
$1 U6.47 .
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