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HomeMy WebLinkAboutPermit Electrical 2004-10-26 125 fiFTH STREET. SPRINGFIELD, OR 97477 . I'H:(541)726.)753 ELECI'RICAL PERMIT APPLlCA110N City Job NUr.lbcr ~~J - ()tPC;.{~ ,-- ~ Sep-30-04 03:14P t."L09A no,,' OF rNSTAL1.A TIO," ,:,," ~\Sl IY\~ c:;+r L .J LEGAl DESCRJPTION 17, v3. 3(". 42. JOB DESCRJPTION (j 3 S-crZ> .L:f ~ ~ t...J/ Gi~,.,....;.r P~rmiti 3rt non-transfaable and expire if w()rk is Jo not started within 180 dll)'5 or issuanct or tr "'ork h: Suspeoded for 180 d.)'" P.02 3, . 6) '"'...Q:I....~~~liU...D ''0 '" ~ ,',,~. . fAX: (541)716'368iP,.~ ,,^">i;~,~..' ~ a Y'/ -'O''f',(/' ":: ."':': i$ll.; . ot,.....o....,'-'. At. $ ~ 0& 71S! /0 - ~_~o.,<;, "'''0<'/''''' ' ~ IV ~""" IS'Go: CO~~Pl.E:J'E Fi!:: SCHE~~ "9",;:."~,, "'?". ~~ ~ fa&. O'~o;i) ....@ ~. l:}~.iS'~. A. ..~.C\) R.~\~~~llIia!.-.5in~l'orMultl- mil)' ~ 'l'lIin~~~~"O~ 0' 0 ,,~ ~~ " '" Out.: Service included " I 000 ~q. ft. or les" Each .dditional ~OO sq, ft, or portico thereo f Each }.~tonUfncl'c !-lame or Moduiar Dwellir.g Service Of feeder 550,00 :':ee~:~:~:~~~;\;~::~\Q 8, 2~::~::.::,~:,~::.~.r,,~.,i_ns,~,li'llon, A;tern:o~~,: Rel:~~: 201 A",ps 10400 Amp. 575.00 401 Amps 10 600 Amp. 5125,00 6D1 Amps 10 10)0 Amp. __ 5163,00 O\'er lO:lO Amps/VoltS 5375.00 '{econnw Only 550,00 " l'fW Alteratioll or EltenslGn Pu Pand 01l~ Circuit Each Additional Circuir or v.ith /'-:L\ ~ 1->' Service or Feeder Permit I 53.00 Owners Name . l..T"I .:.1..'\0J.,\ ';" 1 , IZ ~ Addre..' Yo. ~ ,2Y: ~.l .:: I ~.I~;~!=~J~~~~~ttttlif~c1~d~~;,:E.ch'I';'i~u~ll~n" City StA,4\t2 W,,-,; _ Phone ",110\. pwn"orinf~moruleSarese S50.00 ,,"r. 'f ' -,11 t,el',l\::, OAR 952'001- ~~". ,_~igl'i()J',yi~ l!1gbLiI!~1 - S 50.00 111 , - LimitcdEnerg,dRJ:kilrdil1.ihe rules-or- 5 25.00 OC L.' .1m, 'ile,d,IE,,'~;r"JIG"1ilm'1!;\:lgj\e.p.hul.'" S 45.00 'T'he installation is heing m<=lde or. proper:y I own '.,J.'hich . QI' L " ' I\.q:lv Notlllc",,"''' is nor inlcndcd fer sal-:, ko.:;~ or rent. Minimum f:i[clr it: prr~it I k~pnt..IOU Fee is $45.00 + Surch.r::t5 I. ..,.. ,;.T~,:s32,2;j- "" ", 4. ' SL~TOTAL OF ABOVE Address \)() ~X 2P)2\ CitY~t5'L ~CflLt<Qphone ~S8~ Sup;:rvi::;or License Number 4 "ll\.~ ~ \ D\()\ \D\ Constr, Con"', Numb.. _L5lo 10 LB--- ~ I \4){)S Expiratio:1 Date E,'(piratio:1 Date _Sj~narure ofScoer\'ising F;lccujcian.__. ~~ OWNER L'\'STAlLATIO;o.; Own~rs SignalUr~: Inspection. Request: 726-3769 I'W 1I11!:: 1HiS PERMI1 SHALL EXPIRE IF THE WORK ,\1,11 HURIZtD UNDER 1HIS PERMIT IS NOT l, ',h,r:I~GEO OR IS ABANDONED FOR i\,. I 1 tlO tJAY PERIOD. h . '.:... ,"~. .", . . -;' '. . c. ~:.1eillvo;.ary S~nice;' or Feede-rs' C " "._ .... . :;i. <.'ni~~~.~~~' '~~': ~ '; . :,.1 hutalLuioJl, Ajtcration or Rtlocation 200 Amps or Ie" 20 I Amps 10400 Amps 401 Amps 10 500 AmpE ___ ~~~r?VO A':l~S or 1.00C! Vol~ see "8" abov.c. D. <~'hlllch 'Circuiu " J ..\ . 5 50,00 569,00 5100,00 "~'I . ,._ r.i..' 543.00 3,- .';,' lIl" - <.\,1..2- t., u.O -:I:l. "2- 'Z. ..'.. . 7% Slate Surch~rge 10% Admin:sl;11live Fe: TOTAL Sh.a.-rd Dri\l:(T:}lBuildin! FomulEJ<<ln;o.l P"r:nil i\ppl~liun 1.()),doc <_', 2~ Fifth Street Springfield, Oregon 97477 541-726-3759 Phone . ~i ....a;ity of Springfield Official Receipt .evelopment Services Department Public Works Department Job/Journal Number , COM2004-00948 COM2004-00948 COM2004-00948 COM2004-00948 Payments: Type of Payment CreditCard 10/22/2004 RECEIPT #: 2200400000000001326 Date: 10/22/2004 Description Add, Alter, Extend Circ Ea Add Penn Serv/Fdr 200 amps or less + 7% State Surcharge + 10% Administrative Fee Paid By ROB'S ELECTRIC Item Total: Check Number Authorization Received By Batch Number Number How Received 2102 Ikw 022102 In Person Payment Total: Page 1 of I 2:1I:32PM Amount Due 3.00 63,00 4,62 6,60 $77.22 Amount Paid $77,22 $77.22