HomeMy WebLinkAboutPermit Electrical 4-8-17
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225 FIFTH STREET ...,Oili~r:, L-O~ ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 /,.J' /1 /.......2. ( "....,
INSPECTION REQUEST: 726-3it69 ,t/11-:.,~ City Job Nlimber /' 'TL/ ~
OFFICE: . 726-3759 Autl'lv-.,..;,;~ ~,,;"diUr3--FtJry-- ~T~-FEE=SCBEDULE BELOV
1. LOCATION OF INSTALLATION
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?GAL DESCRIPTIO~ I ~t)2. OJ Z 2.6{)~1
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JOB DESCRIPTION
S e-L-U~ \ ,'-I c:;:( s.-rr-~ '
Sum '\
New Residential-Single or
Mul ti-Family per dwelling uni t.
Service Included:
Cost
Items
$ 85.00
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof ,
Each Manuf'd Home or
Modular Dwelling
Servic~ or Feeder
$ 15.00
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days. '
$ 40.00
2. CONTRACTOR INSTALLATION ONLY B. Services or Feeders
, . I Installation, Alterations
Electrical contractor,!\l1\t\(}1JAL'f{~\1&\~~r Relocation: .
Address 25\ \ vj, ~+t+- S.,.-;
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
City ~ ~l2..- Phone 4~C;--3S(a(a
Supervisor Licen.se Number S \ () ~.t::: l
\ () - \ -q ~
Constr Contr. Number '(0 '3 e~ ~
Expiration Date
Temporary Services or'Feeders
Installation, Alteration or Relocation
C.
$ 40.00
$ 55.00
$ 80.00
see "B" above
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
Expiration Date
.' - . .
Signature of Supervising Electrician
7Ut /h/
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Owners NC3;me M/t7Il.r<~t~ ,~_(djJ;(
Address 45" /,/). 4...etJlfIy)~
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Ci ty &~ Phone ~4 - d$S6d.
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D. Branch Circuits
New, Alteration or Extension Per Panel
$ 35.00
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 2.00
OVNER INSTALLATION
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
The installation is being made on
property I own which is not intended
for sale, lease or rent.
$
$
~$
$
40.00
40.00
20.00 2/'),~
36.00
OWners Signature:
26 tuJ
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5. SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL ;&")0
DATE~--------~~~:7~5?~-------------
RECEIPT.: (/,~Jj-J
RECEIVED BY: 7..(' ~
"'Ill
FENCE PERMIT APPLICATION
CITY OF SPRINGFIELD
BUILDING SAFETY DIVISION
225 North Fifth Street
Springfield, Oregon 97477
Office: 726-3759
INSPECTION LINE: 726-3769
City:
7"/~ /t::'p;rt~r-?#'~ ~r '
Assessors Map #: /~-p< ~?-~L Tax Lot #: ~cr'O P"
Owner: ..4k/;V'y/,7Lf.~-4'? ~~/"~
Address: Y"'?- W ~~~~Y Phone #:_~R~"" ~~
~;::r. Zip:~/ Y~r
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C (~~c.-r,.!"-
of Fence:~
State:
Job Location:
Value
Fence Permit is $5.00
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'"3::> cr I /~/ /:2 ~ Phone #: -=7 7:;> .... ~ Y>g
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City: C~~aF~e- State: .~~.. Zip: ~;;>,YC/r
Construction Contractors Registration #: '"7? /~& Expires: /2. Y~"7 Y
Contractor/Installer:
Address:
Dy signing this permit/application, I agree to call for an inspection once my
fence has been constructed (726-3769). I also stated that all information on
this application/permit is correct and that I was provided with the Springfield
Deve/)me~de4;men ts for fence standards 0'
'V~~ -8-)9-74
~)'ature Date
t/ FOR OFFICE USE
Date of Application:
.zt -/~-'5r
I Y3'$ :>
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Issued By:
JOB #: 0 7'~ =<?s-
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Receipt #
Checked for DelinQuen~ies:
4:'" Gl .:7
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", ----- Checked for Historicc'll, Sta tus:
-
Total Amount Collected: