HomeMy WebLinkAboutPermit Electrical 2003-12-18
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ect as submitted has the following
not require specific land use
225 HI! In STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: ~~~i5~16-3689
ELECTRICALPERMlT APPliCATION C\. ,Zoning,
City Job Number (0wi1...(,(J"O(n~~ Date 1)-'5k-cfJ:> Date
Authorized 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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"CONTR:ACTOR-INSTALEATIQN.ONEY
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Electrical Contractor t A SrS I{)~ € [tU/(J(
Address 38"lS'3 !305C,46{ G~;/Vf
City sPyG{J Phone 7Y/-IY11
Supervisor License Number L/ 7;l 7 S
Expiration Date ) () -0 1- 0 t.j
Constr, Contr, Number J I 7 7 7 ()
Expiration Date I ()- 0 J - 0 <t
Signature of Supervising Electrician
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Owners Name lJ..A'rIJEN EI-JTEKPlo.SfS
Address .;;1611 5\'1 GLACIER t>L '#-110
City RE:()mONo Phone 736- /17;).
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OWNER INSTALLATION
The installation is being made on p,rope~ I oW)! w~ich
is not intended for sale, leas~ or rent. '
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Owners Signature:
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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 Manufac!' d Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50,00
B. ~Sef~iceS~~~F~~de~~~'~I~:Hlli~ ti~~;'?Xi~i~ ti6fl~~9~i"~'Ri}()'"c1Hij"1':~;~' 1
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200 Amps or less.
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsIVolts
Reconnect Only
$ 63,00
$ 75,00
$125.00
$163,00
$375.00
S 50,00 .
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Installation, Alteration or Relocation,
200 Amps or less
201 Amps to 400 Amps
401 Ainps to 600 Amps
S 50,00
$ 69,00
SIOO,OO
Over 600 Amps or 1000 Volts see ",8" above,
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New Alteration or Extension Per Panel
One Circuit $ 43,00
Each Additional Circuit or with
Service or Feeder Permit $ 3.00
E. lt~i~;!f~~~e~~;'iscet>i~~1fe~Mf' n';t)Jitti!i1~d),;'E.cti'ri~t~~~Ji,~1
Pump orirrigation:' _~ Ir~50,()(llnRK
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SignlOutl\'i115i~.!\illl\\1 ~HAll t"rln ~ ;:f1~v~q,q~ ~lnT
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Limited Ese!gy;I,~Q.idfn~iMR IS /-101'11"-' , $ 45,00
Minimum Electi-ii!Pe1-\\nt~~~fc~i~lq..~e i~1 Surcharges
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7% State Surcharge
I!J% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FonnslElectrical Permit Applicntion 1-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00726
COM2003-00726
COM2003-00726
Payments:
Type of Payment
CreditCard
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Receipt #: 1200200000000002622
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Other Electrical Permit
Paid By
ROGER D KING
Check Number
Received By Batch Number Authorization Number
dIm 000251 017864
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 12/17/2003 11:08:S7AM
Amount Paid
3,15
4.50
45,00
SS2.6S
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Item Total:
How Received
In Person
Payment Total:
Amount Paid
$52,65
SS2.6S
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