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HomeMy WebLinkAboutPermit Electrical 2003-7-7 ~-' 225 FIFTH STREET · SPRINGFIELD, OR 97477 · PH:(541)726-3753 · FAX:Tt&4tl>)(llMAg~ect as su~mitted has the tollowing ELECTRICAL PERMIT APPLICATION ~~~~~~'afnd does not require specific land use City Job Number -' f>IJ/fA 2tlo 'J -DD5:~'7 Date 7 /7/0 ? Zoning (L.<U I / - Date -'v- . '7 i --0 ~ 3. COMPLETE FEE SCHl!, ULl::- nJ:!,uh.,- - Authorized Signature ~ Installation, Altera~iQIlor Relocation l,.,.' \i ~ ,...........j- .200 An-ips or less, C -: <;: ~ G.~ ~ '-~ '- . ~t;;)~~~uLI'J!'~'- ..~ . "...', ; .l..:'" 201 Amp~ t04g0Amps:' ", ":.. . ',' ! '. " . ~ _.~. --~ \ -,').. I.'J "-' .J401 A"mpS to, QOOAmps' '~..:_ -' . '.~' -' , ...... .' " .'-I.~ '; ";, "" . . . . .Qyel;'(lOO;Alilpfoi' 100Q Vp-ltssee;~B" above. '- "': l~ . .. :.1., -1 ',-c. ',' ; ." . . .,0.., .:Branch tirc.1fts . '~'._., .....', '..-' ~",~"",,,",,,,~.~iA~"""" ". ~' ' . N~w'Alteration:or Extension Per Panel O~e Circuit Each Additional Circuit or with Service or Feeder Penllit Constr. Contr. Number 1.0 y Lf l.s, S Expiration Date ~. ~5 . (Q '3> Sign'tu1,UT'itClriCi"" , I UJ .~ OwnersName ~LS Address etl11S 5il ') ~~, O1::1l.\) E. Miscellaneous (Service/feeder not included) -Each Installation City ~p~one 1tOT10ro PumporilTigation $50.00 IS PERMIT SHALL E~f!!lIRe4iiif<HEi~~~K $ 50.00 OWNER INSTALLATION l~THORIZED UNDER rnISitt?(BM}Iy\i~!J~ti~1 $ 25.00 _ The in_stallation is being made on prop~f0lVffI.~~ OR IS AiJ\ltN@ffiMW~Qfl)Jllmerclal c..--- $ 45.00 ~) (]V IS not mtended for sale, lease or rent. ANY 180 DAY PEli\1illi\num Electric Permit Inspection Fee is $45.00 + Surcharges 1. LOCA110N OF INSTALLA110N 9 Do BE LJ"'\...lN E. R t> . LEGAL DESpRIPTION ) 703/ S 3 () DIO/;)t) S 1-\ ~ 11. I S -B: :;;l,t>~ JOB DESCRIPTION cc.. IV 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 A 1.. L \ B 1::> S ~ c:.. v R. \..'1 Address ~ 3> SSE ~ CN Ke:N'( City IYCRI'Lf\N" Phone (5l>3) :2.3 J 'll) 5Sb Supervisor License Number '1 S ~ ~ L E f\ Expiration Date \to~1'~5 .1'-. . J' Owners Signature: Inspection Request: 726-3769 /1 7/tjj //lA- A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or Jess 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 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/V oIts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 C. Temporary Services or Feeders $ 50.00 $ 69.00 $100.00 $ 43.00 $ 3.00 4. SUBTOTAL OF ABOVE 45-;-0 , ;] /)- LIS-v ~?"F 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building Fonl1s/ElectIicaJ Penl1il Application I-03.doc 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2003-00587 COM2003-00587 COM2003-00587 Payments: Type of Payment CreditCard Receipt #: 1200200000000001719 Description Low Voltage - Commercial Indus + 7% State Surcharge + 10% Administrative Fee Received By dIm Check Number Batch Number Authorization Number Paid By GARY CHRYSLER ALLIED SECURITY 0114 85805 City of Springfield Official Receipt Development Services Department Public Works Department Date: 07/07/2003 1l:08:llAM Amount Paid \ . Item Total: 45.00 3.15 4.50 $52.65 How Received In Person Amount Paid $52.65 Payment Total: $52.65