HomeMy WebLinkAboutPermit Electrical 2011-2-11
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.. :: .;'CliY'OF SPRINGFIELD, OREGON ,
~ '. ~~ ..-"; ~ J.. . A -,' : I . .. > . .".'
225 FIFIH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72&-3689
ELECTRICAL PERMIT APPLI~TION
City Job Number ~\\ - ~..ry;c;
1. E~j{Q~~JD1:~~_
n/9 L Sl
,
LEGAL DESCl}P'TION: -::z
\rujA-~~5gv os\C9
JOB DESCRIPTION:
';J;1f'DE (}/,- cu / 'A; (J)~r")
.,- . ,_ IW,... _~ %%uJIUh
P~e.~ oweUi!lgluiiitl
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$121.00
$ 22.00
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
$57.00
.~ '. "t-'?, -AW; "," "",Mill!:,};;.> __o>i: ""',"" _~^",,~-il""'i'iIi1!I_ . :;W:b .1__\.,,_
;€()NJ:Ri1GEOR~S1llJ'I'f/fl'fy1JLON;ONIiiYI'~
2. %"0 "f'li1iiiii~rrk'0":t<lW"}k';;z0i;."'$#;;;?iJ!\{-i'0SY?i7;;if?';L0?i@,'i"f~d?tFi0,\;/j~~
Electrical Contractor Every Dl geJ~
Address '1'74'11 ~ P U<..-
City .J()'(\ctM C\~ Phone 9f 2:-') 9'S '7
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 73.00
$ 86.00
$143.00
$186.00
$426.00 _
$ 57.00
LfbO'b5
/Oh/2-o16
I f
(J c']1 ,
gJ 11/ 09
c.
Supervisor License Number
.~ .~
E .-. D~
xprration' . ate
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 57.00
$ 79.00
$114.00
Constr. Contr. Number
Expiration Date
Over 600 Amps or 1000 Volts see "B" above.
~"",
D. ,fan(ili\;~ircui~_~;t{tUlifJ:
.. "t,*",~^,' .....,,,-_,_c," 0?J, ,_' Qlh,,'
Sigoature of Supervising Electrician
1/;w;!2Jt1mr
New Alteration or Extension Per panel I
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
sscv
.
l Q.. ,CO
~o
$~
{P.
E. ~ijJi~[rl~"~iI' jffsir:ri~I~eaerinZitiii.Clu'~d: .:.p~Ealfi~:lh~fjn:ijd~
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A
Address
City .b
Pump or irrigation $ 57.00
Sign/Outline Li!\hting $ 57.00
Limited EnergylResidential $ 29.00
Limited Energy/Commercial $ 52.00
Minimum ~Ie~tric ~ermit ~~spection Fee is $5~.OO + ,Surcharge01
~ (1 ~ ~4. SF1Brc;pf!I~J:j'QRJ!A:Bf!. . ".' rr .
.'Y ~ 12% State Surcharge .
,( 0 ~ 10% Administrative Fee .
'"c:::>O ~~ 5% Technology Fee -,~. ~'1:
InspectW~ue 72Ji;;~?~~ R\\\~ ,\ TOTAL
SXs: 'OV ~\~ iR~~;::-~;:7'M~Q,
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Sigoature:
sr~~.:.-. F. IE~.D. .
~
~~~EGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 81
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.us
811-5PR2011-00228
1319 L 51'
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000276 RECORD NO: 811-SPR2011-00228 DATE: 02/11/2011
IDESCRIRJ'iON'<.\':':2c.>" .>;"'''c, '. -"it, :, ,';, <ilo' .;.", -'" '-":ACC0.Ui\lJiCODE - ',Z~:-; -"lu....:iAMOUNLDUE~k1:<J
Branch circuits with service or feeder each circuit 224-00000-426102 12.00
Branch circuits without service or feeder -1st circuit 224-00000-426102 55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 8,04
Technology fee (5% of permit total) 100-00000-425605 3.35
TOTAL DUE: 78,39
t:.:!"Xx.Njgii:fi'.ijp~,;1;h,; -eAy'QR~ ~cAsHiE'R;'LHoPPER:':''i''~::ft''',::,i:;_QMM~'iifSl~:t;',,;,,,:;:, ''''',iZtt::'l; AMOUNT!,j~ID,,;:':::1't; ',.' 'I
Credit Card EVERYDAY ELECTRICAL 78.39
012231 SERVICE INC
TOTAL PAID:
78,39