HomeMy WebLinkAboutPermit Electrical 2003-12-17
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225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 .'FAXnslflYh6-3689 't-tJ(t." ,
ELECTRICAL PERMIT APPLICATION /1 Zoning. .---. l _._m_.~..~
City Job Number ~ ~ 0 01 [ "\ Date [)-~ ~::;:,;,~:,~:;~,,",~ 1, ~ I~~ ;;P~~~-~-
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bo-r6 It) , LA.
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.
2.
Electrical Contractor r:. A 5,S/t)e fLee 1KJC
Address 3 g ).5"3 BOS(A G ~ Gkl\JG
City SP ~l..{} Phone 7 Y I-I Y1. q
Supervisor License Number L17 ). "75'
Expiration Date ) () -0 (- 0 'I
Constr. Contr. Number J ) 7 7 7 ()
Expiration Date I 0.- 01- 0 <i
Signature of Supervising Electrician
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Owners Name tI A'1Dt/V E N'7{~'t.IJ,( S
Address 362.2 5~ V\I, G LA (IEf( fL ;;(4./)()
City ~ ~ f)1n ~ N 0 Phone 13b' IlJ.2
OWNER INSTALLA nON
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
, $ 50.00
c.
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Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
Over 600
D.
$ 50.00
$ 69.00
$100.00
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E.
Pump or irrigation $ 50.00
Sign/Outline I;-~W~ij.g".:. ...,\~ ?,P:eP\::. \!'JG'cT.\
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Limited Ene~~~~~~~~n S 'C\!\',.~L.r.: \~ ,~-~ l~-5 ;:Q.~\ \ ;j.\ U l
Limited Ener~(~~~~i1~ lj" ',~.'.'. \~"'<,~~~QQ) fOi;
Minimum Electric ~~~V~~tioQ. \t.~~i8': 'Surcharges
','(\\'/7' . V~;"'irrU~."'~~,..'r~l\.Ji""" ,-
4.}~SiYBTot 'OVE',c','; ,
<i..v,-;.';:,: i'-~'-,', ", "" "Y, ~.:2X:<c XihL~t>~}:~,:;C,\<L.,~3/ ,/;.;.,{.~,,' ')~~ ,<' .
7% State Surcharge
10% Administrative Fee
1.-1 <';--
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L-\ '5 ()
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TOTAL
Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00719
COM2003-00719
COM2003-00719
Payments:
Type of Payment
CreditCard
Receipt #: 2200200000000001883
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Other Electrical Permit
Paid By
ROGER D KING
Received By
dIm
Check Number
Batch Number Authorization Number
00251 017506
City of Springfield Official Receipt.
Development Services Department
Public Works Department
.
Date: 12/17/2003 10:49:40AM
Amount Paid
Item Total:
3.15
4.50
45.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65