HomeMy WebLinkAboutPermit Electrical 2006-12-13
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INITIALS N I'--'\.
~A!.. DATE~V
" '"" SOURC ...IV Cj
12..11-60
225 FIFTH STREET. SPRIi'iGFIELD. OR 97477 . PH:(54t)72&-3753 . FAX: (541)72&-3689
ELECTRiCAL PERl~llT APPLICATION
City Job Number CiJr.r! :JODI", -f)/ riJ ()
Date
1. LOCATION OF INSTALLATION: 3. COMPLETEFEESCHEDULE.HELOW
1.f32.. m OUv\'+::l (Y\ 6~ t-e
Service Included
1000 sq. ft. or less I $106.00 J D(o ,
Each addiiiifriiiNO(X~Nf\.,QrjgOllli:lW re',(UIlt:t:. you Iv I U
poniOllft\1ilm>,frules adopted by tho ~V'>'g~rl tqHitlt-l / (
Eachrw.\iUtB~'olRfnfelOter. Those rules afe set forti
Modilra~IGfilfs~iI:tOO10 through OAfl$~&60001
FeedOO90. You may obtain 00";",, v; ,;,e rUles U.l
callino the center. (Note: the tel ethane .:
2 CONTRACTOR INSTALLATION ONLY B. Serv,ice"lU'~F'leeder.sl-emstallatiou. Alteration ,or Relocation:
. IUlIluel,UI.U UIl:lgOII UlIIllY l'Ion 'callan
Eleclrical Contractor 111 f t: lee + C l' C. ~ <!. 200 Amps or lesyenter is 1-800-332-234~hoo
'i) Q.. I ( ^ 0. L 201 Amps to 400 Amps $ 75.00
Address ,0 \:JOX VI UP 401 Amps to 600 Amps $125.00
A I b 51./ 1 601 Amps to 1000 Amps $163.00
City . @.Vl Y Phone glo7. ~ 102 7 Over 1000 AmpsIVolts $375.00
Reconnect Only $ 50.00
LEGAL DESCRIPTION:
i'1 D"::i '3:.<(. 3,<+ 0;;:) 4 CflJ
JOB DESCRIPTION:
V\ e u.J
w'
Permits are non-transferable and expire If work Is
not staned within 180 days of issuance or If work Is
Suspended for 180 days.
Supervisor License Number ::J.. q B () S
lO./-Og
:J.. Lf ':l , 5" e..
to ... t - 0 ~
Expiration Dale
Constr. Contr. Number
Expiration Date
~2'''~~'
Owners Name IQ', J'ey v' ~{le.u 'P:,tdrr
Address ,,(J.O, hox '[3-D'
ci,y51A).n:f~ Phone 51+l-7ot, ~D
OWNER INSTALLATION
The installation is being made on propeny I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
0-CG~: 54L.j(02(
Q;6(J " q \ IsI?- GO!
A. New Resid~ntial- Single or Multi-Family per dwelling unit.
C. Tempor~ry Service~ ~r Feeders
Installation. Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I A mps to 600 Amps
Over 600 Amps or 1000 Volts see."B" above.
D. Branch Circuits
$ 50.00
$ 69.00
$100.00
New ~Iterl\t~~ or Extension Per Panel
OnM-U" . Xp,nr 'r T'1$.4,3!~W
Eac~r'HllIifl~naMjJdli\lo^tIJi'~ "..~"::~. '01
ServA'ilf'Afffl1it:IJ'!!'/!DER 1HI" PFRMI$ 1310'0
!F~IrFD OR IS ABANDONED FOR
E. I\f;,QM~necib'5 (Servlc.<;!(e,eder not included) -Each Installation
ANY 160 DAY PEtiluU,
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
d,CX 0 '
17,100
-.3r:W
:270,(/2 0
4. SUBTOTAL OF ABOVE
8% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL
Shared Drive(T:VBuilding FOnllslEh.."Ctricnl Permit Applil:IUion 8.06.do~
225.Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
.
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, ,~",,^_,".' ,,,-
&- of Springfield Official Receipt
~velopment Services Department
Public Works Department
RECEIPT #:
3200600000000000611
Date: 12/12/2006
1:34:31PM
Payments:
Type of Paymenf Paid By
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
106.00
114.00
11.00
17.60
22.00
$270.60
Job/Journal Number
COM2006-01210
COM2006-01210
COM2006-0121O
COM2006-01210
COM2006-01210
Description
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
+ 5% Technology fee
+ 8% State Surcharge
+ 10% Administrative fee
Amount Paid
Check
G & E ELECTRIC
ddk
12502
In Person
Payment Total:
$270.60
$270.60
cReceintl
Page I of I
12112/2006