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HomeMy WebLinkAboutPermit Electrical 2004-6-25 etas submitted has the following 225 FIFfH STREET' SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~.@g-gg~~ not require specific lend use ELECTRICAL PERMIT APPLICATION . Zoning . 1sJ2-. . CityJobNumber (1)IMZOOl(-0073) Date f,-Z'1-0"-1 Datp (o-06-0<{l, . ~""""''^''r -....~.,AoII1I!>. ...t...>"JJlt'!.."_........_....,.,-,,....%~ r_~_'" 3. r'C01'rIPEETEFE.t;:~Lnr,.uU.u:. nhu ...""-,=,, .', '''''''''':-'''J..' ~:..~..rJl'f~'":;.>~~,"V<-.~<.a:..~~'i.'-'.- .....<l.'li'~~""'~..l.;.;&n...:r.:.. L 'iJ1!OCAfidN:iOFJI1VST.ir'i~TiOM/l~~ ~~~..d.....~'c~"-,..~....~........',.....~;- ","..\,~.,~r~"~ z-f, cr s~ NovAs+- LEGAL DESCRIPTION \ 7 0'3 Z z.. '-\. '--I JOa DESCRIPTION Olj 200 A..~~~~~fiff~i~~~~~4!a~~~s~ Service Included '1 , 1 i A,D1 ~ (' , o'Z.ClA (" +- 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling SelVice or Feeder S106.00 S 19.00 PermitS are non-transferable and expire if work is not started within 180 days of issuance or if workis Suspended for 180 days. S50.00 roCONTRAcrbR'm.:ST]fr.j..~.TI. 'OMONEY.~I B. l~s"e1,~&fs'~;'F~~de~~~.:..ltinft;-U~ti;;'<'A11;':ati6rifo;:Riiitc~li~~:'; I 2. E. '''~'k~~;e,;.''t-t....~",...._"x" __,.,.,'..""7<'t'-...-,!~':.:"';i';H,.,,'.t.-',~.,.. . ,~""'..; ....~..-.:rt.-'F-~.~~-,' .4i? ...._..--,_~i'I-:-~_;-,'1".,...,.~.~_.o-_t~,t:":::!.;,;)li-..,>\; .~,..."',,:, ~- --ti\::l~v<mW Electrical Contractor EAS7:5iiJ6 cLECl/(/evUI8N!W'Al ~fe" \Jt)Oi'GgOfllJtll~ $63.00 _' ~~ 0 . QroBG'l~orilil $75.00 gOSGAGf GANt~ ~6<tMm~lOAR952.(lt)1. S125.00 ~~~~lillllbjlinpso1th0ruI09bV S163.00 Phone 7Y!.IYr1~!n8t'Jt5~~tsthetelePhono - S375.00 ~~on Utility Notificautm S 50.00 C. ~O~i!~11~~;V.~~~fs~~::4".~~ifEJ":~:":~;~ "S'bJ.S'j Address City 5frrLD SupelVisor License Number 'f7)7s Expiration Date )()-OJ -oi..; Installation, Alteration or Relocation 200 Amps or less 20lAmps-to 400 Amps 401 Amps to 600 Amps S 50.00 S 69.00 SlOO.OO Constr. Contr. Number ) /7 7 70 Expiration Date I 0:" 0 J - 0 l/ Signature of SupelVising Electrician Over 600 Amps or 1000 Volts see "a" above. ;; ~"'.u.~_:.>.~..~-._;..>-.:.....:"4'l:o, '.J},,".e""',. <-~',,''U''~-''...__-']J.l''l-'',~ D. tfJ~.'J!Ec.h;G!Il~l;P~ . ~_~;~' _'." '. <+:<v<_ ~:;'_,. .O'S~'::' <.;.... ,,,,.,. '1 ,~,,~' ..",. '. ,-".. \-~':.~'-. ~' f ' . ~94~ New Alteration or Extension Per Panel One Circuit ( S 43.00 Cf 3 Each Additional Circuit or with SelVice or Feeder Pennit S 3.00 Owners Name Sicvb\( ~() I t2.... NoVA 5T ) b'15 S.+>ICO ~...;.....,.o..._-,!. .,....t......;..~,rt"""".~'.,. ... ~'},''"'~-,.''-1!'~~Jt~~) E. ~Wit,~'I<i!le9Jis'(S.~D'ic:"Jf.tde--""n!!! p.icl~<te~) iE;n~~~ltis.t,lU.apo!)~ Address ) -" ... ~b~gatiqp f\ll E){P'R~ If "(HE ~g~~ Sig~lS>R&..~I!ht~OE.~ 1HIS pER\\II\\ 1% ~do L$~ :s~f\BM~OONEO f"~5.00 LuOOli\M~ '\Ye-' $ 45.00 Minimu.k~Y.J~i~ Permit Inspection Fee i@>rSurcharges If) -Sj)~ Lj>= ct ~ z!=E- 4 . f?'S'U:;'#T~.O<'-T."';."60'.AF"."'i>'O'.;:a <',\f ;.~ -:- f,.. 'j' . r. 1.0. nJ,j. ~ ,VL'~.,' ~ "-,0" <:---? to" l~";'!.l"''-'''~~<'i.'''\ .,.".-,;".'-.:'!..r:,.':!<r".'....if:.-...... .-~,f ~.--,?;Il~ "',~ ~. ..",..~.",~~._ '~-,. .., ....'...._....,_. _"".Jt~ City Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 7% State Surcharge 10% Administrative Fee Inspection Request: 726-3769 TOTAL Shared Drivc(T:)lBuilding Fonns/Electrical Permit Application l-Q3.doc 225 Fifth Street . Springfield, Oregon 97477 541-726-3759 Phone . Job/Journal Number COM2004-00735 COM2004-00735 COM2004-00735 COM2004-00735 Payments: Type of Payment CreditCard 6/2412004 RECEIPT #: .j:Q~; ~ ~.". ~ of Springfield Official Receipt .velopment Services Department Public Works Department 2200400000000000848 Description + 7% State Surcharge + 10% Administrative Fee Add, Alter, Extend Circ Minimum! Adjustment Electrical Paid By ROGER KING Received By djb Page I of 1 Date: 06/24/2004 Item Total: Check Number Authorization Batch Number Number How Received 000420 024809 In Person Payment Total: 1:42:59PM Amount Due 3.15 4.50 43.00 2.00 $52.65 Amount Paid $52.65 $52.65