HomeMy WebLinkAboutPermit Electrical 2009-7-1
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225 FIITH STREET. SPRINGFIELD. OR 97477 . PH:(541)726.3753 . FAX: (541)726.3689
ELECTRICAL PERMIT APPLICATION
City Job Number COM2 004 - 014 8 8
Date 6/19/08
I. I LOCATIONOF'lNSTALLATION:-.J 3. r-COJ\'l!LETEFE~SCHEDULEBELOW
Parkinq Lot 5 Service
ZON mU.U
INITIALS N rv-...
DATE 7 - J- <.f1
SOURCE f'n {7-S 00
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LEGAL DESCRIPTION:
A. r;;.;, Residenti~I-=-Single or MulticFamily per dwelling unit.
Service Included
JOB DESCRIPTION:
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling SeIVice or
Feeder
3333 Riverbend
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. r CONTRAcrORJNSTALLATION.~NLY.l
$117.00
$ 21.00
$55.00
B. I Services o~F~;ders--"' Insta.nati~~~,Alterations or Re~o~a!~on: 1
:n~J.Miscell.rieOUS ;~7~~/~~*"~~6~ded) -Each Inst.lI.ti~
*0 e-:\$'i\'lr~g.Jtl.,n \s Pr.?JJ\\\ \ _ $ 55.00
1\-1\S P~t:\\DI~tti\t\l],tfnt~~I\~UO~r.U rU\'\ $ 55.00
~Ul\-1q:i~{,~@J\SfI!}\JR.!1Pdential $ 28.00
CONl~~~J~1\lfrlp~merCial $ 50.00
Mi'ri'iI-d~m Electric Permit Inspection Fee is $50.00 + Surcharges
~------ 1
4.1 SUBTOTALO!'AlJOV!L__ .110.00
12% State Surcharge 13.20
10% Administrative Fee /1..00
5% Technology Fee .'). S"O
/39,70
TOTAL 1 jf' J
Shared Drive(T:YBuilding FonnslElectrical Permit Application I-OS,doc
Electrical Contractor E C Company
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts t
Reconnect.OnlyreS YO\J~'IOt"
on \U\j'l .'-'1 tll"
I I,"[ION: Oreg ,.h" Qreg_on ttoI:tl'
, - . . ac';'.P~' ,.,,,,,,,;];e '''eed
.. 'Hllrt' c. Jj'~PQIl'lr.y.",ervl.c!'S~QIi". ers
. n cen\el. n u,:(." ~"-
t.J\lill;a\\o .OO~ 0 \nrou.g !In rules bY
',_ OAH 952'00~ rnstall.ti6it~~1te....Unn,nrIRelocation
" may OU~c;l'" - . . the ,,6\\:;t-'1 VOo ~
0090.. ~o~"'e cer~OO A!I1'*I'tr.lessNotilicatlOn
\lIng '" ,,,n )l"" V
ca. r 'or the2lH ll'im8s,tq 411,Q.3Arijps
nun Uj.) I . i\ .RO ~"....'-
center 40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. I B'ranchCi;cuit~~
Address
32758 Old Hwy 34 SE
City Albany
Phone Oreqon
SupeIVisor License Number 3257 S
Expiration Date 10/1/2010
Constr. Contr. Number
22-1SC
Expiration Date 7/1/2011
tnle~-
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
10
Owners Name
PeaceHealth
Address
City Springfield Phone 335-2817
OWNER INSTALLATION
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726.3769
1
$ 70.00 70.00
$ 83.00
$138.00
$180.00
$413.00
$ 55.00
.l
------,.<
$ 55.00
$ 76.00
$110.00
$ 48.00
$ 4.00 40 . 00
.- "
225 Fift~ Street
Springfield, Oregon 97477
541'-726-3759 Phone
Job/Journal Number
COM2004.0 1488
COM2004-01488
COM2004.0 1488
COM2004.0 1488
COM2004-01488
Payments:
Type of Payment
Check
cReceintl
.
iIif~
JiiJ.y of Springfield Official Receipt
-'elopment Services Department
Public Works Department
RECEIPT #:
1200800000000000703
Date: 06/26/2008
Description
Perm ServIFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
EC COMPANY
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
DJB 3820 In Person
Payment Total:
Page 1 of 1
2:2S:20PM
Amount Due
70.00
40.00
5.50
13.20
11.00
$139.70
Amount Paid
$139.70
$139.70
6/26/2008