HomeMy WebLinkAboutPermit Electrical 2003-7-7
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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