HomeMy WebLinkAboutPermit Electrical 2005-4-13
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~;~i541)72t-36"8%:;%o;',,:, ,'~;,L :
ELEclKlCALPERMITAPPLICATION '\., :x ~"/ I')OI'~\S~(,r.' ,',
City Job Number ~_?~ -(>/1)"2 Date "~h~"'-fr&9v/~;il&0'1J.
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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, Permits are non-transferable and expire if work is
,i- not started within 180 days of issuance or if work is
Suspended for 180 days.
B'i';:C^:" '"'C_"~^'~:-_:'"~-'''-'''-'-'''--_V~''''JSS+;''' .__..,:;:;:, _ _ _ ___ _ _ _ "
2. :_~?!f!!~1:Sr,?~~If~7:4LIf~!~~ O~L~,
Electrical Contractor _ "'5EC:::u (6 E:C.H t.. TN c....
Address :5/1./ AJA;:"l"I'\;+h HlVD
City &'1) U1 e-
Phone 5<) -.:< B37"J
Supervisor License Number 3.< 95 ;5 LEfJ
Expiration Date / () / / I () )'
Constr. Contr. Number
/,5c'~/R CCB
Expiration Date
8/0:s-
I
Sign.lure on'ing E7
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Owners Name C~./tI < ;c:.ocrl
Address / 2-'J Y _A-uJC;{ A;/"
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City tv4, / ~fMPhone ~ ~ ~ - J!l../....r
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OWNER INSTALLATION
!hAinr~jaN~ ~~ffl1I~lf~EfUlf$ yBty~d"hich
is llilfcWseR~f/~ti~1ifa~~%'Ef~regon Utility
~otific~Q!.1Cen!er. Those rules are s9tforth
)h~7{R~?Jbe1-001 0 through OAR 952-001-
OOSO. You may obtain copies of the rules by
'-'QllilIY 1I n:; \;1::11(1::1. \f~ULI::. L11e: id\;:;fJIIUIIt1
number for the Oregon Utility Notification
Inspectio~siP. ~~'M92-2344).
SP~!lMOIFIE:U::;
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A. R~si~~~tiaJ:Si~*h\g~~lll~ti~
Service Included
1000 sq. ft. orless
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$ 19.00
$50.00
C'-',;':"...:':'F"""'.."":"+;:?~:--
B. S,ervices or Feeders -:- Ins~allation, Alterations or Relocation:
~^J; ,'.,A.. ~".,,,. ,", .~. .... ',~L ~., ." .
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.
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50,00
$ 69.00
$ I 00.00
Over 600 Amps or 1000 Volts see "B" above.
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D.Branch Circuits'
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Pennit
$ 43.00
$ 3,00
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$ 50.00
$ 50.00
$ 25.00
$ 45.00
f. )'60
Pump or irrigation
Sign/Outline Lighting
Limited Energy!Residential
Limited Energy/Commercial
"
M~~u~c~~~H~fiS ~,~~~l!tLIn~p'~~~i?f1'f~~is!$~~;,Q() + Surcharges
- -' _ _ .,-.:--:<t',:,: :.: .,--r--, -"-'-,--,-' -_<~:_:.'.:. --",:<"'<::,-,>r~ - ,. '~"_~ C'"::~::.":u~-,,-:-'--:r' '.- -',::::r_ '(Y"
4:' u'sUBrofiAiJ (iF:ABQh>(:,::;,!Jil)5,;j 1,1 J
C .2': ,/ '1;.ii~/.":g"E,u~()i~;?;}~' P,~-,~,>/-\f\~t}0~,~\:3J rU;',t~ ' -"
f\ i ,i 7% iSili~ stiratar'g~ O.
10% Administrative Fee
TOTAL
4.-S- t) 0
, ;{,/J-
4)-0
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Shared Drive(T:)/Building Fonns/Electrical Pennit Application I-03,doc
225 Fifth, Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
'elopment Services Department
Public Works Department
Job/Journal Number
COM2004-0ll52
COM2004-0ll52
COM2004-0ll52
Payments:
Type of Payment
Cash
4/13/2005
RECEIPT #:
1200500000000000442
Date: 04/1312005
Description
Low Voltage - Commercial Indus
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
SECURE TECH
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
dIm
In Person
Payment Total:
Page 1 of 1
12:09:21PM
Amount Due
45.00
3.15
4.50
$52.65
Amount Paid
$52.65
$52.65