HomeMy WebLinkAboutPermit Electrical 2003-7-7
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number C.OVVl Z-O C :3 - 000 9 if Date
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1.
LEGAL DESCRIPTION
/70:3 'Z 74 (
JOB DESCRIPTION
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.l21Lq- ,~ A-01/17tJ~
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.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
/
Supervisor License Number \-S.tv
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Expiration Date h/ '
I'
CanstI'. ContI'. Number
E ' , oj'
~xplratlOn, ate
S' Ifs " EI "
19naturjP upervlsmg ectnclan
Address
t:J
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5 ][1]
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Owners Name
City
OWNER INSTALLA nON
'y~L ~e fOllowing prOject as submitted has the fo"o~jng
_/ , ~nlnQ, and does not require specific rand u
approval. se
3. COl\lPLETE F'E'~~EDULE BEL01V Q.e)
Date 1-~,,-0 ~,
A. New Res1WPm1iafl.d ~1i\~~ .M:uJ.ti-Familv pe~~g unit.
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
$106,00
$ 19,00
$50,00
B. Services or Feeders ~ Installation, Alterations or Relocation:
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpslVolts
Reconnect Only
8
$ 63.00 J~ ~ '
$ 75.00
$125.00
$163.00
$375,00
$ 50,00
J. .I' "j~' , 'et ;,,:retUp'o^~ry.Services or F,eeders
, ,'--d DY tIIC\."-'.::'
" :,-,. " 'J'Jl8,
.{\....i.....--j'. ':"'~l\.......... -.'-' I ',-it ,~;\ '.";.\\'_',.-:: ~.'" __ ~.
, ' , " '':;,' .t'~rns'tallation, Alteration or Relocation
'1\." '~'\" _,\r.....~ (joG11.r::;-1 :." ',"'.1'
'., I;....::':> '" ',',~;,_ r,,2QOl\mps~odess
. c"," "I "',' .' l ,'I - _ ."
'.C~i. ,'~,.;, I . ,',,,,~ 1;\ 20~~ Amps~to'400 Amps
.',: ;~ :,..,;- , ," ~'':'' ,,,... ,~46l,,:Afl1Ps' to 600 'Amps
'.", "'~.'~'.:1~,1
~: :,;11 I'" ',~' ',~, ." "Over 600 Amps or 1000 Volts see "B" ahove,
D. Branch Circuits
$ 50,00
$ 69.00
$100,00
t\UJJTUCE'
TI-//~,., ",,' . One Circuit $ 43.00
~T ,;J&:ii~~~~Ws~~~~~~cth I S- $300 L{ ~
_.R~ kj~~~/DAY PfR/i!8.B'!iJOOIJ'f!ft~bR~Tce/feeder not included) -Each Installation
Phone 7~? -3235-; Pump or inigation $ 50,00
r ' Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45,00
The installation is being made on property lawn which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
New Alteration or Extension Per Panel
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. ,SUBTOTAL OFABQl/E
JD~~~
I
?: 5".6
/ ~,~~
r
/"7 ;;'Se:,
/ -- ~,
Shared Drive(T:)/Building Fonns/Eleetrieal Pennit Application I-03,doc
7% State Surcharge
10% Administrative Fee
TOTAL
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00094
COM2003-00094
COM2003-00094
COM2003-00094
Payments:
Type of Payment
Check
Reccipt#: 1200200000000001721
Description
Add, Alter, Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Received By
dIm
Check Number
Batch Number Authorization Number
Paid By
Q STREET HOLDINGS
506
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 07/07/2003
1 :23:22PM
Amount Paid
Item Total:
45.00
63.00
7.56
10.80
$126.36
How Received
In Person
Payment Total:
Amount Paid
$126.36
$126.36