HomeMy WebLinkAboutPermit Electrical 2006-1-10
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
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Electrical Contractor nt(... fl l..J..J1 ~ S,...:..~{'f ,', J200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
City Job Number
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
ddress
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City <] f ';J...
Phone ~ ~C:, I S7 u
o Supervisor License Nunlber
wxpiration Date
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\J" Expiration Date
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Signature of Supervising Electrician
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Owners Name ..r'MK&:f ~er
Address 2f- '7 LLaY~~/~ (d~~/~~
City ~JerA Phone 9J:J-7?tJ1-
OWNER INSTALLATION
The installation is being miidoeon property I own which
~fil~~lfed for sale, lease or rent.
00&~BaMliTr6HALl EXPIRE IF THE WORK
_AIITHORIZEll.U.NDER_IHIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD. 0
Inspection Request: 726-3769-
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Date
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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
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.
Installation, Alteration or Relocation
, 200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps '
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volts see "B" above.
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuif or with
Service or Feeder Permit '
$ 43.00
$ 3.00
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Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Lil1}ited Energy/Residential L.--- $ 25.00 2-5' tt0
ATffiliiMld(jjM:r~r~gJ!i1l11~tequires you tO$ 45.00
Mt,)i~~l~l~c1flP}JWtNa ~st~~hg~EIQQlj], ~4~!tM + Surcharges
Notific9ti()9Q~nter, ,...lq9~~nJlg~.. 9r~,~elfQ~l:t,,0
.1;o1~~~mg(j;;=!o~r~~~~r;!;t ~5:":
ca1f(Vl~'tllfeS~lw~ (Note: the telephone 3,.
nuriroi'ieAfturi_6~ Utility Notification L::/ 5"0
Center is 1-800-332-2344). "'--A' 10
TOTAL ~ ".,./,
Shared Drive(T;)/Building Fonns/ElcctJical Pennit.Application I-03.doc
225 Fifth Street
Springfie1d, Oregon 97477
541-726-3759 Phone
~''''Y of Springfield Official Receipt
.;velopment Services Department
Public Works Department
Jo~/Journal Number
COM2005-00957
COM2005-00957
COM2005-00957
COM2005-00957
Payments:
Type of Payment
Check
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1110/2006
RECEIPT #:
2200600000000000040
Date: 01/10/2006
Description
Low Voltage - Residential
Minimum! Adjustment Electrical
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
M & R WOLF ENTERPRISES
INC
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
dim 9769 In Person
Payment Total:
Page I of 1
1:54:28PM
Amount Due
25.00
20.00
3.60
4.50
$53.10
Amount Paid
$53.10
$53.10