HomeMy WebLinkAboutPermit Electrical 2006-3-9
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225 FIFTH STREET. SPRlNGFIELD,OR 97477 . PH:(541)726-3753 . FAX: (541)'726!3689 :~i;~::'~~:; ". . ~"" ' \.....
ELEcrRlCAL PERMIT APPLICATION ' ",,_"V ~'gMMti< H '
City Job Number C-OlMzco6- Or:::)f~8 Date 3- '1-0G.
,
1. LOCATION OF rNSTALIATION
4 $""3 AO....E'E"- '?lLvJ"i ~J
LEGAL DESCRIPTION
i 7C 3'1 $"" z '3. 07 too
JOB DESCRIPTION
Acid
R c.(rc..~~+\
3.
COMPLETE FEE SCHEDULE BELOW'
A. New Resid~ntial.- Single or Mulll-Family per dwelling unit.
Service Included
1000 sq. ft. orloss
Each additional 500 sq. ft. or
portion thereof
$106,00
$19.00
Permits are non-transferable and expire If work Is Each Manufact'd Home or
not started within ISO days of Issuance or If work Is ~~ular Dwell~~ ~t'i'(.if9CJf~: Oreqon law re$50rOO; you to
Suspended for ISO days. e er. .f?lIoW rules adopted by tile Oregon Utility
2. CONTRAC'J1~TALLATION ONLY, B. Services 0~:Feid.n0In~lIailiIDJAllerallons"oi\IRel6Caliiln';J
(' t. . 'in OAR 952-001-00io through OAR 952-001-
Electrical Contractor tlr.QOn:u\-l() I'J 200 Amps or li:SslO, You may obtain cOOlt$'63!OOle rules bv
t:)f\n ~.. ~ . \'L 201 Ampsto4OOJ\~' the center, INote:$i75.00leohone
Address n""M'1ltl \ ~ ~ 401 Ampsto600~rfortile Oreqon Ut$I~5~ootlfication
n (. '" 601 Amps to looo~enter is 1-800-33&163:06).
City r::. I c,- 0 IA. I Phone ~l\\)lt~.Qq05 Over 1000 AmpsIVollS $375,00
'\ Reconnect Only $ 50.00
\ ':) lA.6 s
Supervisor License Number
Expiration Date ~o,.,
Constr. Conlr. Number .!to.!;l..5 'Oc....
Expiration Date '1 \ \ \ ~014
Signature of Supervising Electrician
10];).~~
Owners Name L,,^ l~ L.e- ~ ..... k...........
Address 1>~ ~." IOOZ-b
City t.-v...G-t:Ne Phone
OWNER INSTALLATION
The installation is being "",de on property f own which
is n9t intended for sale, lease or rent.
Owners Signature:
3
C. Temporary Services or Feeders
Installadoll, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401~to600Amps $100.00
Over ~O...tl&~~ 1000 Volts see "B" above.
D. Bra~dMwr?T 3HALL EXPIRE IF THE WORK
New ~t5l\,'~?l'r{I~~t'O'Aa~fi.Ji'~~~ERM/T IS NOT
One CifFJf. L. IS ABANDVNEIl ~IDW
Each AdlhtiJ~a9 J1~~ifJi~. 7
Service or Feeder Pennit $ 3,00
lf3
21
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation
Sign/Outline Lightins
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25,00
$ 45,00
Minimum Electric Permit Inspecllon Fee Is $45.00 + Surcharges
4. SUBTOTllL OF ABOVE
blf
'5'L
t.l(O
7-'~
8% State Surcharge
10% Administrative Fee
TOTAL
Shared Orive(T:)lBuilding Forms/Electrical Permit Application 1.o6.doc
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Wit
.-;ty of Springfield Official Receipt
.evelopment Services Department
Public Works Department
225 F;ifth Street
i'; Springfield, Oregon 97477
541-726-3759 Phone
Job/Joornal Number
COM2006-00 158
CIJM2006-00 158
COM2006-00 158
COM2006-00 158
Payments:
Type of Payment
CreditCard
l.r
:,
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1.(
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3/9/2006
RECEIPT #:
Date: 03109/2006
1200600000000000276
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add'
+ 8% Slate Surcharge
+ 10% Administrative Fee
Paid By
PHIL ROSE
Item Total:
LhecK Number Authorization
Received By Batcb N umber Number How Received
njm 954131 In Person
Payment Total:
I of I
11 :08:48AM
Amoont Due
43.00 .
21.00
5.12
6.40
$75.52
Amount Paid
$75.52
$75.52
.