HomeMy WebLinkAboutPermit Electrical 2003-12-17
rOJeCl as submitted has the followIng
as. not require specific land use
225 J'lHtl STREET 0 SPRINGFIELD, OR 97477 o. PH:(541)726-3753 0 FAX: (541)726-3M1!ng
ELECTRICAL PERMIT APPLICATION q Dale .
City Job Number (ClVV' ?.oO~ 60 "10 ' Date ,-~/ ~--rr:? AuttlOflzed Signature
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
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Electrical Contractor EAS,s/()f. €L€C1/(IC.,
Address 38.lS.3 B05C,4G{ (,~;"'€
City SPyL{) Phone 7Y/-/Yt.'f1
Supervisor License Number LJ 7). 7 S
Expiration Date ) () -0 ,- <' If
Constr, Contr. Number ) I 7 7 7 ()
Expiration Date 10- 0/- 0<1
Signature of Supervising Electrician
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Owners Name l-IA'rO(/V C"'7f1.PI!..JJfS
Address 3bJ.J 6.t..,AUa.. f( -#/10
City 1<Ei)/)?oI'D Phone 136- 117;),
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OWNER INSTALLATION
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The installation is being made on property I own which
is not iptended for sale, lease or rent.
Owners ~ignature:
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Inspection Request: 726-3769
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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
$106.00
S 19.00
S50.00
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B. 'lfSer.vices:or,,', F, eeders "'lristanatiori,,~lterritions, Co'r;Relocntion: ?','
Q.~~"-<" "rC'l.;.-,.""~"\~- 'AlhJ"'~'l ,". y.-..:.~~~._.... o1Tl"';.,!_,:" ,.~D.j."
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to I 000 Amps
Over 1000 AmpsIVolts
Reconnect Only
S 63,00
S 75,00
S 125,00
SI63,OO
S375.00
S 50.00
c. n:I~~~~!~Q:~$~~$:Orh~4J~=:~.~ ~'~;~~:;~4',~:'.. ~.~ ~:.~:.J
Instanation, Alteration or Relocation
200 Amps oriess S 50,00
201 Amps to 400 Amps S 69,00
40 I Ainps to 600 Amps' $100,00
Over 600 Amps or 1000 Volts see "S" above.
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New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feed~r Permit
S 43,00
S 3.00
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E. 1::~~c~!!'ln!9,iis'(S,e~2c~fgde!c n'!t~1c1!,~ed) :*~~ch:lrist,aUa.ti~J
~ 'NOR"
Pump or '" ,~~', \-IPlLL I')(PIRe It S q% ~\rIi
SignlOU~~g~g^,i 5lt.meR 11-\\5 Pt~~~~feR
Limited E~'\;!Y.fllJlSiJ~'rla\R IS !l.MNOU~ffi,oo
, ., ""':f,,\t:Mr,fDiaI " S 00
LlID1ted EI\S\~~l>uomme~ PeRIn. I. . 45,
Minimum Electnl~~~ PnspeClion Fee i~+ Surcharges
4'[~,$SUHTotA:r;::OF.ABOYE.:' i ';:~k;:;~,J L1 C-
t -.',.....,:";,,~,.,.. .;:T~~.,~.~..;--;:>' ...~., '--.~:..~..':;,... ,~:-~{ -'.J
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LI. <:;0
'S 1- ~&:)
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:YBuilding Forms/Electrical Pennit Application 1.o3.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00725
COM2003-00725
COM2003-00725
Payments:
Type of PaymeDt
CreditCard
.:
~~,
Receipt #: 2200200l/IJ\J\I\JlIl/IJ,M 7
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Other Electrical Pennit
Paid By
ROGER 0 KING
Received By
dIm
Check Number
Batch Number Authorization Number
000215 017413
City of Springfield Official Receipt
Development Services Department
Public Works Department '
Date: 12/17/2003
1I:05:I2AM
Amount Paid
Item Total:
3,15
4.50
45,00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52,65
$52,65
.
.
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