HomeMy WebLinkAboutPermit Electrical 2010-4-29
ZON
INITIALS
DATE
SOURCE
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--,~'; CIT;Y:OF SPRINGF,IELD, OREGON'
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SPRINGFIELD
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PEFJ):{IT APP.{JP4TION
City Job Number ~ - \ \o~ u
1. . S'l'~()N:
C"',",'- . "'e<' me w
m
Date
3. :Ci!fJpmI:;EfJ{FEE-SCiiEijT!illJ}BE[;!OWi"
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A.
LEGAL DESCRIPTION:
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Service Inclnded
1000 sq. ft. or less
Each additional 500 sq. It or
pomon thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
JOB DESCRIPTION:
$121.00
~iAdd~
Permit are non-transferable and expire if work
not started within 180 days of issuance or if work is
Suspended for 180 days.
$ 22.00
$57.00
2.'~@it~giiftiflLii:T;g~jl&ii'
Electrical Contractor Every 1).( tie ~
Address '1'7l[CJl ~yJ P I..R.-
City..:J()'f\d,'M C~ Phone 9/2.--295'7
""g{ ill .,..;"m'Wl:J ,'m"',limiL', '25" T:.! ''''l;"')- .""'w o. '-,' -,"' '0: 'ifl" "*'ill"l"
B. ':Servi~FolOP.Eeelle'i!!#,.Tils 'IJjjfion.~f~rations.ol1,:Rlll)Cii'tio.-1ffii!h'
. ,-*,J0Mffi.0C;1m'J".11iiF')1ffirl!iWill@!Hj:,";'illi!~m:t".0ffiJTk1##\ji%\01ii1i="i"''''_~w ,~,,"^. . . .. :":- . ""'0'Y"iffi,,!1;-
~SfpO
$ 86.00
$143.00
$186.00
$426.00
$ 57.00
l
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
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f 3(,:311
'3/12/ 09
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Supervisor License Number
~ -'
Expiration-Date
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 57.00
$ 79.00
$114.00
Constr. Contr. Number
Expiration Date
D.
Signature of Supervising Electrician
14ML~--m
Owners Name ~ \'Jill.Jt-1n l )~ (_
Address <~\0- 2)~ '5'-F
City ~~ ~ Phone /0
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 50.00
$~
[<;).cO
.8
Pump or irrigation $ 57.00
Sign/Outline Ligbting $ 57.00
Limited Energy/Residential $ 29.00
Limited Energy/Commercial $ 52.00
Minimum Electric Permit Inspection Fee is $52.00 + Surcharges
4. 'slYBmi:M:i:@E;EO c;6
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12% State Surcharge
<'I' \' 10% Administrative Fee
~ ~" CD' 'I, 5% Technology Fee
InspeCtiO~equest: 726-3769 TOTAL
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
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Shared Drivc(T:)/Building FormslElectrical Pennit Application 7-08.doc
RECEIPT #:
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22010000Q0000000418
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 04/28(2010
12:21 :02PM
Job/Journal Number
COM2009-01640
COM2009-01640
COM2009-0 1640
COM2009-0 1640
Payments:
Type of Payment
CreditCard
cReceinll
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Clrc Ea Add
+ 12% State Surcharge
+ 5% Technology Fee
Paid By
BREANNE ROSENBERRY
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, PaRe 1 of 1
Amount Due
81.00
18,00
11.88
4,95
$115.83
Amount Paid
080022 Phone
Payment Total:
$115,83
$115.83
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4/28/2010