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HomeMy WebLinkAboutPermit Electrical 2009-12-3 ~. I ~a" E ~:;.~ -~.... ~ ~'5" +.:::- - ,'# ~- ^:tt~~qJ~;;W,i":~~rN~!I~~,~~~Q~ ',~i1.:~ SPRINGFIELD '" aL~ /9/os/o 7 Date ZON INITIALS DATE' SOURCE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(S4I)726-3753 . FAX: (541)726-3689' ELECTRICAL PENfIT APPLICATION City Job Number (,(-l,- ()/1'd ~ 1 1. ILOgTIQMQJimSTAf:IfAfliJJV: ~ 3::>7/ c Jas j)~v ,?)~. f - LEG\Yl)r~14 D~CO ..--' JO WDE SCRIPTIO.;g .,/; _v j/J n ' /l.. ,[3,/ ~'(/':J"'" I _~J...jCAc) Pe~mits a~e Don-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 3. f CO~PLEr.liFEE!i.GitEiJ~fBEi.11W -,,1 A. b~~"wR~sid:'!t.i~I~SirigleorMijliHia'ffiiiy P!i-.iiwell'i~g.unii" I Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $117.00 $ 21.00 $55.00 2. ~;J'P~~ctQ!l:IN~.t4LqrroN",(}~t;~ B. ~,~tii~~..0~];~lJ!~iJ~~,tall~~~';,Alt~ta!i.o~~,"~~~eLo~~1j~n:.,J Electrical Contractor J36f(j h '7;" e.v- Elt/:...-rIZIC- 200 Amps or less $70.00 201 Amps to 400 Amps $ 83.00 Address /9;1) roC/1/'{.'- /11A.ol( fJv-<...- 401 Amps to 600 Amps $138.00 60 I Amps to 1000 Amps $180.00 City fi'r''1-ll.....c Phone /9;;'1'7173 Over 1000 AmpsNolts $413.00 r ~ b'i5'1 (po t( [.. Reconnect Only $ 55.00 Supervisor License Number '7 c; ?c:;- 5 C. 1''i;;'Dlpo;'';,.y;~;-rVi~Cs,orF~~(Je.fi, Expiration Dat~ If') - \ 0 _ r t> Installation, Alteration or Relocation ~3 _ ~ 200 Amps or less ~ ~,OO--- Constr. Contr. NUJflber '91, "2. 7 '" 201 Amps to 400 Amps $ 76.00 401 Amps to 600 Amps $110.00 Expiration Date } ()- 10 - D '7- j/ /0/1 () . Over 600 Amps or 1000 Volts see "B" above. Signature ofSEpervising Electrician D. t'Bfa~ch''CiI'cuiiS'"l';~:l1" ,-: -- i.! &ff J 1~ ~::;~:::tionorExtensionp~rp~~:,I'IO $48.00 - " Each Adm~r~if5\',it:!ll'lWi\flU\f"~~ Ufllity Owners Nami-S/-I GU?ON /?1AS ON :;r~~S~n~~:~~r~X~~r~j;~:~~r 4.0:,++ "+'''! 1 Address 3:;r7t \.....,'as fUY ...e..J;J Jt.l9!'~H '96!~~(f\~,.&'(~~gZ!;;\l.'!ti'!~IUcf!!(t)'!:.EaCljl~stallatI~n1 NOTtr'/:. In OAR may obta\~. 'he t9',8;;"""" CIty ~ I/J;;t..--- Phone ~8JPlffl&'l!lWXer. (NO\~ii\iW "nliiicati()\$ 55.00 . HIS';fc~fT SHALL EXPIRE IF THE WORK S3'btHli~rlt!llbtQg:~g~_332-2~"'4). $ 55.00 OW~~Rr.NS.'f.AI!i!~ffoN-/'S PERMIT IS NOT Limited 1ll~\!\;iaentiiIl $ 28.00 !h;;~:t~fiMI6~.~s.9r~W1age~~l['p?&jJeHyf(lJWn which Limited EnergylCommercial $ 50.00 IS not Intended for sale,li'ease or rent Minimum Electric Permit Inspection Fee is $50.00 + Surcharges . OWners Signature: 1\.01 -~ '" 4.ltSrJii'FOTAE+OFABO.VE.';'.'if;;:,;), I / S lfU \,~~~_~\) ~"--' " ......-.. "+++'''+'-'~''-'''.j, lo '7' . \,,:t(' \{}.\J$;\'O ~ :~~~~:i~::;::,~eFee --/. ~ ~ 5% Technology Fee ~~~~:~:i'?~~;.:~ TOTAL :/t7.3 . f I 'J' \!d~' .::~ ~ '~~"""""",",'-- -"";~. ,~~ 225 F "th Strcet Spri"fi~IQ, Oregon 97477 541-726-3759 Phone Wi:~ City of Springfield Official Rece\,t Development Services Departmcnt Public Works Department Job/Journal Number COM2009-0 1722 COM2009-0 1722 COM2009-0 1722 Payments: Type of Payment CreditCard cRcceint I RECEIPT #: Date: 12/03/2009 2200900000000001347 [ Temp Power 200 amps or less + 5% Technology Fee + 1,2% State Sc. .1... 6'. Paid By Bud r l';:"nCI\' ELECI K.)L CheCk N,imber Received By Batch Number Item Total: AuthorizatIOn Number How Received 130855 In Person Payment Total: njm , u.( r I ,~ D ( /\J G 7 C/ vU /" ,k t L~~1JYU r--t j)[tVLU~ // Page I of I 10:35:20AM Amount Due 63.00 3.15 7.56 )IJ./1 Amount Paid $13.7/ "Jll[" 12/3/2009