HomeMy WebLinkAboutPermit Electrical 2003-7-8
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERNIIT APPLICATION The following project as submifled has the toll owing
/t... _ _ zonmg. and does not require specIfic land use
City Job Number l..-<<)Vl 2dfJJ -61) 5g6 Date t. t . t():?:> approval. (I
Zoning ,~
3. COMPLETEF1W~~CHEDULEHELOW 1-9; 'o~
C/"}LJ
I. LOCA110N OF INSTALLA110N
I<7,D1 Pl0Ne6R f'CIlQK\NF\'1 G~ST
Authorized Signature
New Residcntinl- Single or Multi~Falllily per dwelling unit.
A.
17034230zfOZ
Expiration Date ~. ';)., So ' 0 ~
Over 600 Amps or 1000 Volts see "B" above,
SignatureZf.....,pe7iits' lectrician D. Branch Circuits
New Alteration or Extension Per Panel
" . - 'II" \".1 J
i\J\pne'Gircuit
/ ~ '-' V ., '" ~(.'.\L." \,-Fach, J\d.ditio~~1 Circuit, or with
Gl... "".: I C ""ll','" ',Se'<:lce'or Feed,er Penmt $ 3.00
Owners Name ~ ll,\'~,.. ",,\." ,-, ,'., .
Addre~ 53!lP~u ~ 0 .QlJ;I:.@,~~;~~.~~.isc,ell.,n;oous (Service/feeder not included) -Each Installation
City ~_ Phone l"I,I',Pump or irrigation $'1 $ 50,00
Sign/Outline Lighting \~<;.~, ~!S~ $ 50,00
Limited EnergY/Re'{.~(i8T- \r\\~\\ \';)~" ~ $ 25,00
l\~\ed 7f1'j\i'l!>t\"n'{'fi'Ei:ll~~t.\I ~ $ 45,00 45:<:7'0
~~(l!,up'i;'Eltt~1d~\~t \l.i!J;p~ion Fce is $45.00 + Surchargcs
,W ~}~,?SL't- <;J'r- \';)
4.\>.\'8;J,~;U:f~ ~VE -I5:a-o
(,<;JWI \) 'i);\ '. -
il.'fo\sfu~e Surcharge J I}
10% Administrative Fee // J ()
s.i
LEGAL DESCRIPTION
SJ.HH1..1'S ~1 \s.1
JOB DESCRIPTION
c..S...l V
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
CONTRACTOR INSTALLATION ONLY
2.
Electrical Contractor PI Ll..1 G'l> S12<:.UI'\, li't
Address 935 Sf ANl:.:\;N~
City Po Il.,. LAN)>
Phon.(5tl ~) J. ~ 1 .95'5 b
Supervisor License Number 3. 5 "l <6 L E ~
Expiration Date I ~ ' I ' ~ :;
Constr, Contc Number bY Lj lP 5
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
./t 1/7;6} jJ/th
Service Includcd
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 Relocation:
200 Amps or less
20 I Amps 10 400 Amps
40 I Amps 10 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
$ 63,00
$ 75,00
$125,00
$163,00
$375,00
$ 50,00
C. Temporary Sfrvices or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50,00
$ 69,00
$100,00
$ 43,00
TOTAL
Shared DrivL'(T:)IBuilding Fonm/EIt..'Ctrical Pcnnit Application I-OJ.duc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00586
COM2003-00586
COM2003-00586
Payments:
Type of Payment
CreditCard
~q!>;:~." ;
Mt"'~.~," ,i
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Receipt #: 1200200000000001718
Description
Low Voltage - Commercial Indus
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
dim
Check Number
Batch Number Authorization Number
Paid By
GARY CHRYSLER ALLEID
SECURITY
0114 24716
City of Springfield Official Receipt
Development Services Department
Public Works Department \
Date: 07/07/2003 10:57:07AM .J,'
Amount Paid
Item Total:
45.00
3.15
4.50
$5Z.65
How Received
In Person
Amount Paid
$52.65
Payment Total:
$5Z.65
.
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