HomeMy WebLinkAboutPermit Electrical 2003-12-8
Jth* u~- 10-2-
4 '. .~. ~ CITY OF S~_,~INGFIELD, OREGON (~:I
. .
225 J:lU Itl STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · ~~~\S~~IJ~~~~A8~ubmittedhas the followil)g
ELECTRICAL PERMIT APPLICATION . '.. dr,o -does not require specific land use
CityJobNumber CtlJ::t?2..t%l:?~OI7'2..cpate i;)._8-0~l,_luval. (1~
. - ZonlOg -
"'.' "\ I .....I ". ' i '""l .")0 !
;' ',../-y,:.",' "-IU'_'S.'
, "'iiisfullation;,',~~,ttluJoiJ.:..q~l'R~location
'1/,,11 ',.",,';:' Q
. c::> 200 Amps or le~,s/', 'iIC~U(),
(,)\ 33C>rt!QY!C[' 201 Amps to 400 Amps
I _ 0- _/'- cT"G/s PE . 401 Amps to 600 Amps
\..9- D \......... ~" RMIT SHALbfJf6tf@Fiilii
AU I HURIZEO UNC}5. pl~
COMMENCED OR IS
ANY 180 DAY PERIO )ew .'i~~ "'Hhtension Per Panel
-' 'be CrrcUIt
Each Additional Circuit or with
Service or Feeder Pennit
1.
41) ~(),M
LEGAL DESCRIPTION
~r()Y1:...pie IJ
JOB DESCRIPTION
u fl ~ sru.d
17PJ;Js- )/I:J~
().r e C:-{) n) .
R.e /ot.a..:/-e
()-~Anlp ~eru Ice
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.
Electrical Contractor L \ \-\. f<\C){ (' ~& 8\e.c...-\v; t.
Address ~~ oW\~ ts\:'-
City'30, ~ CelL Phone L~l' o%\.)
f' \ . , ,
"."'. .
. ,J,
Supervisor License Number ~C)
Expiration Date \0- I -G<-f
, '.
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
~?J~,
V"- V'
. .t-
Owners Name ks ~~..
Address ~!l t'ijp
City Jl ~ ~ Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3.
,~,I hJ' ILUU Signature
A.
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.
;',
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
~O 1 Amps t~ 1000 Amps
'. ~'Over..;IOQO,AffipWolts~ yo,. "
. .- . :t.........,. -'''''. ,_
Reconnect Onl~ cYO. jUt",.
, 4- _~ _ .~'. I. \ -II: ' \ f
-. .Ir u'~'Sa~~.-. .,~t
. . J . ) '/' ..;;. r.. .7"
f
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
r.o-J .00
",
.c;
$ 50.00
$ 69.00
$100.00
$ 43.00
$ 3.00
E.
Pump or irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
U1 '3 . GC:::)
4.
7% State Surcharge
10% Administrative Fee
to\. l\- \
~.30
J"?) .1 \
TOTAL
Shared Drive(f:)/Building FonnslElectrical Pennit Application l-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-01220
COM2003-01220
COM2003-01220
Payments:
Type of Payment
Check
J
...
Receipt #: 1200200000000002569
Description
Perm Serv/Fdr 200 amps or less
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
LH MORRIS ELECTRIC
Received By
dim
Check Number
Batch Number Authorization Number
105886
City of Springfield Officiaf Receipt
Development Services Department
Public Works Department'
Date: 12/08/2003
2:11:40PM
Amount Paid
Item Total:
63.00
4.41
6.30
$73,71
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71