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HomeMy WebLinkAboutPermit Electrical 2003-12-17 ,;' a~ Sullli1illed lias the j'ollowin0 0; require specific land use ~ 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~~~-~- 1. ~~Eli[1i{Qff]JKiilJ1~'i&if1:Tio: 3. ik,9fJl!f~~tiEt~~~~fl~i2~~~.;~~f~~Fij~}1~4; bo-r6 It) , LA. LEGAL DESCRIPTION ~/ /~O2-~.? J!, 2f1#f& JOB DESCRIPTION c ~ p l-c f-c, 'yJo 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 'f&qY-1 , i6'vrw ) D. 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. '~~,;J 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.\ ~\;_"'-~'-_.-_7\,'3 It:'''f':.J\i~'1 -1 i. l' 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 <';-- ~, Ic) L-\ '5 () ) 1- -(is 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