HomeMy WebLinkAboutPermit Electrical 2006-11-1
L{Yrf.
I ()/oll 0(,0
SPRINQFlttL~-M-,.;") \
~~~"f'T(T21 ~
I ' "'-. ~'-,~
Date \\-O\-2...csOCp
"
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
',",
City Job Number V:Y>\ 2. aO' 0 - O\3.~
Signature of Supervising Electrician
o New Alteration or Extension Per Panel
.h, 2 One Circuit / $ 43.00 -'Yd
J I / Each Additional Circuit or with , C
VI, . '2.ClO Service or'Feeder Permit _ Y.q..l~~rolhK /5
OwnersName\...\..\\l~~ 5..""", l Jr-C'a1 . J '''''','_~, \-I~\ \ FXP\\'It: II .'",. '" Mnl
'''' --- I t 1"\\'\lI~' - ...111t:' \)\-t"\I\,l111 ('~ I
Address C7\ 0 'd.. 'd.. (:) ~ \.e....~ ~ In, E. Miscellaneous ~$~rl::,ifl'L(.,eller,uotln'c!Ji,Qed~;f.ach IllStallation
.-.- .. '.: t"' \'Ll",:,' SllellNUo-~f
City\~ I (\ ~ o....f"l.,,,,,, Phone Pump\o,,\~g~tion' LJ OR \ $ 50,00
(Q@'~ q(OCo~ Sign/qU\line,~ightihgPER\OO. $50,00
OWNER INST ALLA T\3N Limit~d Energy/Residential $ 25.00
The installation is being made on property I own which Limited Energy/Commercial $ 45.00
is not intended for sale, lease or rent.
1. I LOCATION OF1N~'ZALlATION I
;;) ~ I -t'OJ1 C.~_;~~J2,~
LEGAL DESCRIPTION ~
\'\ O-::L '30 ~3 OO'\Ot-
JOB DESCRIPTION
(q <\.c\.\0-~ (0 Cl.v<Jl ~k<,
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, I,CONTRAcrOR INSTALLATION ONLY I
Electrical Contractor ~ C,
Address teno .0 2grH-sr .
City~{(,.JhAtZPPhone liV1-'Z213
Supervisor License Number ~-5
Expiration Date I D-l- 01
Constr, Contr. Number I '2-L'7L
Expiration Dale
s; ~ 7-7....-07
Owners Signature:
Inspection Request: 726-3769
3. I COMPLEI'E FEE SCHEDULE BELOW
A. !New Residentiai - Single or Multi-Family per dwelling ullil.
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
$106,00
$ 19,00
$50.00
B. I Services or Feeders - Installation, Alterations or' Relocation:
D~~oc~ $~m
201 Amps to 400 Amps $ 75.00
401 Amps to 600 Amps $125m
601 Amps to 1000 Amps $163,08",,,'
Over 1000 Amps/Volts ., , ,,' ',' $37.?,,0~\\I\'v
Reconnect Only 'v...... .";'0' ,'\.pO'i"SrSO.OO .41"\,"\\
"-1'1\ .... .." r
,'I ~ d'\llC 'J, \~~a,V~ \
r' ._,t:\.v, ~~l"d..~' ..f'\I\
C. I Temporary S~b'ic~ or FeCder~
No\\\\"'~''''"'1-JU IV'" , un"c, ..
\ n q5?-C,' 'p COOICS ,\'1one
lostallatioO\lAlteratlonor Relocation te' 'i11C tcleP tion
':"'('\('\~ '(ou 'III-oJ tei ,NO' ....\~\:\1\cg
200 Amps'oiless q fne cen " __ \ r,i\i'$' 50.00
r.;",\l\{l h O{VV~. .,.....:\A'
201 Amps to 4006:l,np'SJf t"C -'"n ,\",,?,.$ 69:00'
401 Amps t6'600 A~~2,,\()r is 1,,, $100.00
Over 600 Amps or 1000 Volts see "B" above.
D. I, Branch Circuits
Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges
4. I P:.lJ!JT0(MU; OF ABOVE
ex; U-UI ~
'9% State Surcharge
10% Administrative Fee
TOTAL
~
<>V
I s-g:
0;;.'1(..)
.A/.{'~
S. K'/"l
-1/. 3~'
Shared Drive(T:)lBuilding FonnsIElectriclll Permit Application 1-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2006-0 1329
COM2006.0 1329
COM2006-01329
COM2006-0 1329
COM2006-0 1329
Payments:
Type of Payment
CreditCard
cRcceintl
.
RECEIPT #:
-r~,
~.
.. of Springfield Official Receipt
Wvelopment Services Department
Public Works Department
3200600000000000561
Date: 11/01/2006
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
STEVEN J,
HADELBERG/ALERT
ELECTRIC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm 001250 In Person
Payment Total:
'Page I of I
9:33:48AM
Amount Due
43,00
15.00
2.90
4.64
5,80
$71.34
Amount Paid
$71.34
$71.34
1111/2006