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,
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LEGAL DESCRIPTION
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JOa DESCRIPTION
Olj 200
A..~~~~~fiff~i~~~~~4!a~~~s~
Service Included
'1
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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
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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
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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.
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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
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Address
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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
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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