HomeMy WebLinkAboutPermit Electrical 2007-7-13
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Date '7,-' ~ - 01
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number C / ,- f)() ~3 J
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1. LOCATIONOF1N~1'4LIATI01V.:' 3.
d/ 50 ~C('~f;f'~"{\Lp
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.
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2. :CONTR4CTOJjlNSTALLATIONONLY"
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Electrrl Contractor
Addres'i\.
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Ph/
City
/Expiration Date
~
Signature of Supervising Electrician
Owners Name '~t~ q IOjlfL
Address ZIB) ,WJ Lvdi <j;'7 )sPJ}/ / (p
ci'<'..~~d Phon,~}lLj(}.-lgq9
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COMPLETE FEE SCHED ULEBELOW
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A. ~~ N ew~~~identi,a.I-_~i~~~e.~~.,~u.lti- F a":l_ity .J.l~r~wellingu nit.
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
$117.00
$ 21.00
$55.00
.-
B. il.Services or Feeders - Ins!~llation, Alterations or Rel~cation:
, .' _ . J.' <', v, <,;. " . - '.~ :": '-, ..... .>
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 70.00
$ 83,00
$138.00
$180.00
$413.00
$ 55.00
c. ,!,emporary S~rvices?r Feeders~:
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 55.00
$ 76.00
$110.00
Ov~r 600:~mI>s or l~g.o,V?lts see.':B" ab~ve.
D. : Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 48.00
$ 4.00
~
~
E. 'M~s<;ellaneous (Service/!e~der ~ot included) -Each Installation '
Pump or irrigation $ 55.00
Sign/Outline Lighting $ 55.00
OWNER INST ALLA nON Limited EnergylResidential $ 28.00
The installation is being made on property I own which Limited Energy/Commercial $ 50.00
is not intended for sale, lease or rent, AI II:~gbtQ~~3.9 Fee is $50.00 + Surcharges
follow rulff~~~)(ihA O~RQTUtltity..~.. 4' f ~
Notification center.~.1'noserUtefitlf'.iE&fbrttL': " .., . 1.0 '
In OAR 952~0f0~aljl~OAR 952-001- -;::;'l-; 0
0090. You ma~taVw~~aS\0m~ rules by ',~ - to~
calling the cMAtell.ch(N~ ~e telephone LJ. - Co Q
number for the Oregon Utility Notification Jr c / . r/
Centti~~OO-332-2344). {b I....:)\.(J... 5x
Shared Drive(T:)/Building Forms/Electrical Permit Application 7-07,doc
Owners Signature: . r
73'y.ktL ~ ;zI ~
Inspection Request: 726-3769
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-00831
COM2007-00831
COM2007-00831
COM2007-00831
COM2007-0083I
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
2200700000000001130
Date: 07/13/2007
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 8% State Surcharge
+ 10% Administrative Fee
Paid By
CANDI L. ROHOSY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
njm
1482
In Person
Payment Total:
Page I of 1
2:51:31PM
Amount Due
43.00
3.00
2.30
3.68
4.60
$56.58
Amount Paid
$56.58
$56.58
7/13/2007