HomeMy WebLinkAboutPermit Electrical 2006-10-31
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S~P;i:;::J. ~~~IALS .
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number~'2.o'"D(,,? - 00 5"1'1
1. tOCATIONOFINSTALLATION:. ,,;;
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LEGAL DESCRIPTION:
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JOB DESCRIPTION:
Vi'cko duJ-cv.~
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2, 'coNtRACT(jRrNS~Aii{\iI6NONiy"
Ele~t~ic:lco:~tor - ~"l) .~~ '.~.-
Address . 42U, A W. 7~. k. .
City ~1tM.O.. Phone to ~;- ~+<6
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Supervisor License Number
Expiration Date
Constr. Contr. Number \ S1 q~ ~
\\ I, I 01
Expiration Date
SignE~~
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Owners Name 1(\l~~ ecV\sh
Address ,'11> t1 \-('('0-1 ?o~
City evc,~ Phone "H -'S>,O
OWNER INSTALLATiON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
. Inspection Request: 726-3769
Date '<;:1/ 3.l I '20-0<;"
3, " C,01l1PLETE FEE SCHEDuLe BELOit! '"
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A. ;' New Residential- SiJigleor Multi-Family per dwelling unit.
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Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
ponion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
.O\:~. . _. ,'; , ..:. ; :,~,~ - _. .....- ,--
B. .' Sen;icespr Feeders - Installation, AIt~rations or Relocn!ion:
_.-'- ....,.- . ~- -_..,~- -.- _.. '"-.- .
20'ti'lrlf~~ brl~s~'" :.,' '., ....., . "'1"" "$ YO'S; 6'3.00
TOllow rul&" "d'JOted by the uwgon u.qa"
201 Amps to 400 Amps . $75.00
;\iolJ\lcGdon t."mel. rhose rul"" a'I;: "tJ' ,,,ct' .
"n"OI Amps,to 6001AmpsO th h - - - -- $125.00
VMn ;jO~~UU .uu I rOUD ""'''1 1 ';;;I.J2.UUl
c~OJ0"1PYJ'!r!g90.:,1JpJ1~1 Copi~s :' ~~: ~:.JI~h6~.pO
O'(,eJ:I!.99Jl:MJPJ!Ni9!!~. (Note: th~ .nln::-hoMJ5.00
~!'S!W!JCSC.t R,l/IYne Oregon Utilit~. ":~"::3~dR-00
1''''--' Gpl-1tc"k".1---l1go-~1?--2344}. ..-. --..-- -- -
c. ' Temporary Services or Fecd<;rs
~ --.-'-'- -- .-. ...~- - ,_...... - -.-
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
N 0 T~lU&.:mps to 600 Amps $100.00
TH I S0'JeRMbTA'irtp~ ~t (,QQP l)WlfIS'ffi'l:l'WIm~
AUD~OB~;(~[h~~1!i~ THIS PERMIT IS NOT
~~ M ~~,t/ ~ftPr:l1l1,Jil.AI\JAOOIOh'I!'!T~Rel
y Bla &~Ii'ERIOO $ 43.00
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
..
E. .. Miscellaneous (Service/feeder not included) -Each'Installation
.,_ ;.u \ ..'.., _.__ .
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 + Snrchargcs
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$5.35'
Shared Drive(T:)/Building Fonns/Elcctrical Pcnnit Application 8-06.doc
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4. SUBTOTAL OF ABOVE
8% State Surcharge
10% Administrative Fee
5% Technology Fee
TOTAL
225 Fifth S'treet
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-00577
COM2006-00577
COM2006-00577
COM2006-00577
COM2006-00577
Payments:
Type of Payment
Check
cRcceinll
. TJ7";~
Ilk..
Ci~ Springfield Official Receipt
De.pment Services Department
Public Works Department
RECEIPT #:
2200600000000001527
Date: 10/31/2006
Description
Low Voltage - Residential
Minimum/Adjustment Electrical
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
THE HD STORE
Item Total:
Lheck Number Authorization
Received By Batch Number Number How Received
njm
7420
In Person
Payment Total:
Page I of I
I :58:07PM
Amount Due
25.00
20.00
2.25
3.60
4.50
$55.35
Amount Paid
$55.35
$55.35
10/3 1/2006