HomeMy WebLinkAboutPermit Electrical 2004-8-18
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CITY OF"SPRINGFIELD, OREGON '
SPRINGFIELD ,
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (S41)726-:J6's9 CIa. "s A!..
ELECTRICAL PERMIT APPLICATION 0"1. ~o"i^ '>0 ~~ 'It. 'J'iIW
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City Job Number ct./-" -vlf\~~'l Date ull,or' ~~ _s/J. .""'11,
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~ A !l\::Nl'1!('-R '''d'~t' I S"~I M"I""F~I '~~~I' ....;"'-t'i\lll .
LEGAL DESCRIPTION ,~~.U!lla ,,",--!!!g~_..!! ":...~~~ViRt.~e ID ~
/7.().~ '34. 2-2 OO~3~ Servicelnc1uded
JOB DESCRIPTION 1000 sq, ft or less $106.00
Each additional 500 sq, ft. or
~ t!/ACU/n portion thereof $ 19.00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work Is
Suspeoded for 180 days.
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
2 ~t~ONTmtGteRJINSTJi7m;r-7ibNiONDY. B. ~~~j~~t~F1~~lts~Iri~tihi'atioi1'~AJ'i:~tf~JM'r~Rel~lciitlioln'~
. I... ".111... II...... ~l,.,'Iio,..~....";,,,.u.I;,rl~I~~~~~:Oreg~la~reqiJiresyo~o.' ".~ ,,1. 11.,_.,",'1 ,,,i/...., ,II.. .,.
Electrical Contractor ~U"'l,!) t-y{01}l""~z.29Pt&200:AiTIps orlle~:m Utility $ 63.00
NOllilcation Center. 20DAfups ioc400"Amps forth $ 75.00
Address ~oX'9 ",--S-o 'A / ~,OAR 952-001-001a6i1J\riijfs'to.600lAmps.001 $125,00
uu~u. .YOU ;nay obtatOI~~nipft6'16001Amps3 bJ $163.00
City,.)1.o / ~7r;;;t=1o!_ Phone "7 o;iZ~l~~Sr::enter.O~iRtiOOb'1A,{,p~N'6Itsne $375,00
i1ui,iC,,,, 'v the Or6R:ecorhll:\;it0nl}i:Jtification $ 50.00
Center is 1-800-332-2344).
Supervisor License Number "::{ 7,') r.::. ,C::; c. iliie"ID"p'o;~ry'ISer;yices orlFeeilers
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Expiration Date
/0 )0/ /c:lOO'/
, ,
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "S" above.
D. B~~cli~eWkoit's~'
$ 50,00
$ 69.00
$ 100,00
Installation, Alteration or Relocation
Constr. Contr. Number
/S-RRr1.<!
Expiration Date
.:J J;;J-</ J.< 0 '0 ~
c
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)S' ature of Supervising Electrician
(? 0_. ~ _ /1' New Alteration or Extension Per Panel
_h <>-L-L~~:J .IV ~TlDA.- QneClfcUlt '-- $43.00 -I-3~O
- lHIS PERMll SHALL EXPIKtlr THE WCE'a~hAddltionaIClrcuitorwith - J-
,"' n~_Ii,.;n/.lfpERMIT IS t-S:ei1Viceor FeederPennit -.:::> $ 3.00 - .,.-
Owners Name . "L'tWIfI'(;)~ _
'74flJl~ " - S1:fjANUUI~tD FORE I!'MiI\'''.'''''''''I''1 "~.". ""I'('S"'.' ; '. ".' .. d". ,.~-,~,.! 'I"d""Ln. ~ E".' ,"hll' ""11 .,1I"
Address ~ 16 D ,G"Ci~' . .,..~,~..,~~~~~~~~,r",~",.ee ~r~jlDc ~ ,u!iil_,a~. ~sta all~nll
CIty ~ . Phone 7~-/# 7 Pumporinigation $50,00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee Is $45.00 + Surcharges
4. er~.lr~p:0>""'" 59?~
4.0'-
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OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding FormslElecuical Pennit Application I-03.doc
225 Fifth~reet
Sprtngfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00387
COM2004-00387
COM2004-00387
COM2004-00387
Payments:
Type of Payment
CreditCard
8117/2004
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RECEIPT #:
a~.'-.-\i..
~
....-.i
a: o. f Springfield Official Receipt
....~Iopment Services Department
., Public Works Department
2200400000000001065
Date: 08/17/2004
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
HOLLY MAHAFFY
Received By
dIm
Page I of I
Item Total:
Check Number Authorization
Batch Number Number How Received
000475
R4 I 506 In Person
Payment Total:
4:01:07PM
Amount Due
43.00
15.00
4.06
5.80
$67.86
Amount Paid
$67.86
$67.86