HomeMy WebLinkAboutPermit Electrical 2005-7-6
The following project as su e fol~/O';-
pc:, Flot requl If S _
sP~ii~f:U71m::b
, rl.. 1j.J.~
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FA)Q;~1)11' J6pn ~~~,:. ''':
ELECTRlCAL~ERMIT APPliCATIQN Aythonzed Signeture l\ " ,
City Job Number (UY72,pJ6 -nOj;:),";;). Date Q7/(?rnl;))/17') 6 ;
. . . ..'" _." "... ,_ '._ .' , _...' .;... I. .' .. .
1. 'LOCATIqNA.fJNsi'XitAnoN."J:fi{;;;<;;,fi 3. rcoM'P'LilmRsCHEDuLE\BElOWli~~;;:,'"-~r,-'1'itt;:"':\
39[iS'"'>-'~h?;;~'" '.. \ ',"~""""-'"--'~'-=""-'-'~'" ,"__' """,N ,...."..::c.,.. "\
LEGAL DESCRIPTION A. ~~Kif~~li~t~f~~~~~1~1~4'~~~~~i~~~iV~1~bj
I J( ();( ~ -VI 0&3 o-v Service Included
- .
JOB DESC~ 1000 sq. ft. or less
J.. T - .1 / ,/;\ n JI /L '^ L d Each additional 500 sq. ft. or
!..1fJ2)f-/ _ ~ :r...~'" K.-Ull0-ctr'"pomon thep,ef>fENTION' 0 $ 19.00
<\. .. . regon law reqUIres you to
Permits are non-transferable and expire if work is Each ManutactldlHbme,\l.Iiopled by the 0 . .
" not started within 180 day,s of issuance or if work is Modular~Iilwelling:Sersi9!;~Ij-. Those rUle~e",~~~~~ty
Suspended for 180 days. ' Feeder 1/111 G)AR 952,001-0010 throuoh ~ rtJ-
.;:"'J"'V~"="''-'''''''''''-<:'S'''''''''_' ."---~~ f..~~"f,.vo;::r<h ''-'''1}):Slll'''''''''aii ;\' _~A&-B~2-Qa1 .~ .. 'I
:'lec:::~::O~o/~;;:~~~:~ ~,B'2:::;~~~~!IJ~~:i; 1~:~~~c~tiin!.,
, 201 Amps to 400 Am~~er IS 1.800-;;l32-2341,$.75.00
401 Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Over 1000 AmpsIVolts $375.00
Rcconnect:Only S 50.00
$106,00
Address m . R,.'x
1/ 9..'1
City c..R(Or:;1,1~' iL Phone
99.5'
9CJ!,?
. .\...
Supervisor License Number .:J 9 70 -,5:
C r',;:r-"";-;";":"'s';:: ~':'6L AF:';~I.T!,:.~~'fflft;~. '" <I
. ~.'~.~p~.r~~.. e..~~!:St!l~{_^el~"!~s-, ',,', ,.:t"r3"-\')~""'- \' , . . ~ ,j -'E~' '..::..J
. ",I........U'~.....~I,r".........."n'" ,...;.
Expiration Date
<r - /S-- c ff
"" ) (l'J Ie: :>P",\ln(\';~D FOR
Installation;'A1teration or'Re1ocation
200 ~~s~on~s PERIOD. $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
. f":="-::::r.i-'0""";-";"; '~~.; ", "t'"'"~~, ,.' ".f, n-_ - 4. ~ , .... ,- . I'
D.. Branch',Circuits->,",'",. :: .Y'. . .: ~,.'-~':';:/"" .:. 'I"-~" "~71
,..........._."-~..-..,,.~~.--.... '(" ' . ?
Expiration Date
/tJ-/-<=-'/'C,
Constr. Contr. Number /, <;"'9 <"3' '7
Signature of Supervising Elcctrician
New Alteration or Extension Per Pane)
One Circuit /
V Each Additional Circuit or with ""'
~j, /)/)/ /" _ Service or Feeder Permit ~ $ 3.00
Owners Nam f-/ U LU1/n 'g1 qt..,
Address3<?OS ~ ItJ/J1 Ii 0HJ "E. ~~lliieIlap....~~:(~;~6i~etf~~d;eijio(iD~,Med)-7~ft5b i.ns'talla_1J,~j
Ciry ~() ~R _
OWNER INST ALLA nON
(}i~~
QE~<A'
$ 43.00
-</.<
~
Pbone
Pump or irrigation $ 50.00
Sign/Outline Lighting S 50.00
Limited EnergylResidential $ 25.00
Limited Energy/Commercial S 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. fJSUBfofAl:f)F1&H~;:,,\::':,:.';,.;:,:~\,;:?"j ) J:l c;-o
~",_"':.,h~i::~_"'~ ,-~"L .: :"\v_'o,~-""';'i.:::Z.:~;~.:....;~.::...J ~_~
7% State Surcharge G -<;3
10% Administrative Fee
The installation is being made on property I own which
is not intended for sale, lease or rent
Owners Signature:
Inspection Request: 726-3769
TOTAL
-<; 9~
$07.33
Shared Drive(T:)lBuilding FonnslElectrical Pennit Application I.{}J,doc
225 Fifth Street
- Springfield, Oregon 97477
541-726-3759 Phone
~J J
: J6b/Journal Number
. ,
COM2005-00822
C.OM2005-00822
COM2005-00822
COM2005-00822
Payments:
Type of Payment
CreditCard
-! ,
i
!
'f
.
.
:: J
.'
\
"
.' .
7/6/2005
.
RECEIPT #:
iiinM,
aity of Springfield Official Receipt
_evelopment Services Department
Public Works Department
2200500000000000887
Date: 07/06/2005
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Paid By
C. PERKINS ELECTRJC
Item Total:
Check Number Authorization
Reeeived By Batch Number Number How Received
njm 128776 Phone
Payment Total:
Page 1 of1
1:26:40PM
Amount Due
43.00
6,00
3.43
4.90
. $57.33
Amount Paid
$57.33
$57.33