HomeMy WebLinkAboutPermit Electrical 2003-6-12
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (54Il726-M.lI:?as submitted has the following
The tollow'mg pr i 'ecillc land use
ELECTRICAL PERMIT APPLICATION J / zon)llll, end does not requITe sp
City Job Number LbWf'Zo03-0 0.3 '77 Date I ( .:) ~~~ C!.J2-
Zoning !,~/A-1
l. LOCATIONOFINSTALLA110N 3. cOMPLETEFlt3fIt$('U'Io'PrJUJt1i.Luw C?\ ,
.'} A.c t> Cj DL.' AUthorized Signature. -
. 0--, ~,
LEGAL DESCRIPTION U I A. Ncw Residential- Single or Multi-Family per dwelling unit.
I 70 J 25'-( Z. 0 /l.{O 0 Service Includcd
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
. . 60 I Amps t'b'IOQO fmps
Cityf:.,./C.~ Phone 6B,~.7()17 Over,1000At1lW~0Its
. ~v..V ....n\' \,-'
V o."Reco,,!,ect'~n!y,\ ,,0
\,\ \r\.eu '3-f..w ~f)""J
0~v N\\' :\.t.~ ..--,.''''' ~-4::.."-
Supervisor License Number ~;>?-I V S- ,\~...J' ~\e6 ~C.sc_Te'mporar).,Ser\'ii~s or Feeders
. " Q..)" "\('U \\f\" ~ ~"-' X\Q\<O--
# "." ~es'3' :l,e\' \'((.0 'pe,t' ,,\00 ",\\0(\
Expiration Date /'I <: ~, ,~~ GU\\ 0'0,\0 Instiillation,'Altofa1ion or Relocation
- - . ~\:""" u~ 1'\" ..,..\{\'"' ~e'.\.\' I~\U"
\0 "\J,)-\~ .'I'\)'v 0:\" 200,^mps;or,less~~'
/0' -:7~' 0,"'- ~'l ~" \," f)"'"
Constr.Contr.Number f( ":>6 't:.u{',1>.;,;\".,~' ~\\\C20IrAnlRs,t0400Amps
~~./ ~\ :;::<:)\l.'~~ t'\,,"l_~;~(\40}%11Pst0600Amps
E ' , D /^ D "v ,'\(\, \0" 'e'
XpIratlOn ate {/. ..... .\\
,. ,." ,'\Iv::" Cp(\\r~' Over 600 Amps or 1000 Volts see "B" above.
(\~ D. Branch Circuits
JOB DESCRIPTION
A.O-D-.,AJ~ C-t TLC-v\ G
Pcrmits are non-transfcrablc and expire if work is
not started within 180 days of issuance or if work is
Suspeuded for 180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor G 4, &..-- "E r.J)~
Addressf/:l.OC; L- K~
Signature of Supervising Electrician
~
Owners Name ~
Co..rf...~
~<->;''<-( AliCf
Address 2772<;'
City ev..&f::::FI/P:
Phone
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
1000 sq, ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19.00
$50,00
B. Services or Feeders - Installation, Alterations or Reloc<1tion:
$ 63.00
$ 75,00
$125.00
$163.00
$375,00
$ 50.00
$ 50,00
$ 69.00
$100.00
New Alteration or Extension Per P:J~el r / t
One Circuit I $ 43.00 '-f J
Each Additional Circuit or with 'l'l\~ 2
Service or Feeder Permi! ~ ,~~ '\~ $ 3.00 . ') 0
'i:~\~'t. ~ ~\, \S
I:;.~!\1isce~~'Q).6:l.~~~~'~bll\ncluded) -Each Installation
~~,\\\J ~\, fIJ't;.?o. ~'O<:;J
'\~\~ \P~~~~~~~~ \>.'01>' $ 50.00
",'U'\~~'ilThe~~. $ 50.00
c.(,)\tI~~~rgY/ReSidential $ 25.00
",~~iled Energy/Commercial $ 45.00
Minimum Electric Pcrmit Inspcction Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
7-2..
51/
7JO
1> 6~;L.
7% State Surcharge
10% Administrative Fee
TOTAL
Shan..'d Drive(T:)fBuilding Fonns/E:lcctrical Pc.'T1t1it Application l-Q3.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00397
COM2003-00397
COM2003-00397
COM2003-00397
Payments:
Type of Payment
Check
6/1112003
City of Springfield.
Development Services Department .
Public Works Department
Official Receipt
Receipt #: 2200200000000001036
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% Slate Surcharge
+ 10% Administrative Fee
Paid Ily
GLOBE BLDG ELECTRlC
2:25:4IPM
Received By
djb
Date: 06/11/2003
Amount Paid
Item Total:
43.00
30.00
5.11
7.30
$85.41
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
85.41
$85.4 ]
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