HomeMy WebLinkAboutPermit Electrical 2004-8-17
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 · FAX: hS41)728~ft89;/,l.9..o
ELECTRICAL PERMIT APPLICATION . ~ <9,& <?;' 006>; i'
City Job Number CiJJ,bt.., A\'\..;/ -t)() 2v' .5Date t:1- I ~"t.<00,..,. ~0/,l0.9 "01,..,<9<5' <5't.<6
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1.
3~ 3..!B tL/~~M//~~.
LEGAL DESCRIPTION
17l} ? 3l-~,4 !lIS?;?
JOB DESCRIPTION
,T~~~n~
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 STbu[:.
Address t (), t3dA. 'Tls~ i
i-mvcJ-
City bvk Q1'{u " Phone
~81 \. ~~&.s;
Supervisor License Number
JSTf,S
Expiration Date
/0 ~ I - Oi
Expiration Date
/4-1;"fB
4.-Jo .- (5 S
Constr. Contr. Number
S;~aru" ;T~i~
Owners Name ~.(~$";W /JAYZ{'
Address 2' / ( .j. CUvk~~
City ~11 f')f/~hone ~ -f( ~!
3.
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
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
60 I Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.
Installation, Alteration or Relocation
200 Amps or less ;____ $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
D.
.("2r
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E.
Pump or irrigmJs. PERMIT SH,AI' f:Xe.IOO~fOlfHE WORK
Sign/Outline W&fPfelRIZED UNDI=R THISmMlT IS NOT
OWNER INSTALLATION LimitedEner~~me1fD OR IS ABANi>m!IDD FOR
!he in,stal)fr.', m ~~w~el<tm1EfS'Vefu to Limited Ener~~rIf~ff<f>>\Y PERIOD. $ 45.00
IS not mtvo~i1d~~~dffp<tetflfJy the Oregon UtilityMinimum Electric Permit Inspection Fee is $45.00+ Surcharges
Owners~m,i,q~~~n Center. Those rules are set forth4. L --c:> ~
In 'OAR 952-001-0010 through OAR 952-001- d
0090. You may obtain copies of the rules by 7% State Surcharge j ,Sa
calling the center. (Note: the telephone -_
number for the Oregon Utility Notification 10% Administrative Fee S ;_~
Inspection Reque6efiaw~()J).800-332-2344). TOTAL ,~A J ()
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Shared Drive(T:)/Building FonnsIElectrical Permit Application I-D3.doc
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
'-'.+y of Springfield Official Receipt
~velopment Services Department
Public Works Department
RECEIPT #:
1200400000000001221
Date: 08/17/2004
10:33:05AM
Job/Journal Number
COM2004-00813
COM2004-00813
COM2004-00813
Description
Temp Power 200 amps or less .
+ 7% State Surcharge
+ 10% Administrative Fee
Payments:
Type of Payment
Check
Paid By ,
SUSAN JACKSON
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
50.00
3.50
5.00
$58.50
Amount Paid
dim
16215
.In Person
Payment Total:
$58.50
$58.50
8/17/2004
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