HomeMy WebLinkAboutPermit Electrical 2013-4- i
Electrical Permit Application DEPARTMENT USE ONLY
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225 Firth Street•Spnnglield,OR 974774 PIR54 0726-37534 f1 X(54 )7263689 'b -OREGON
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Date: ! //QM 1
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for I80 days.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Cost Total f P ea. cost
CATEGORY OF CONSTRUCTION -
Residential,per unit,service included:
❑ Residential fJovernment A Commercial 1.000 sq.R.or less(4) $147.50 S
JOB SITE INFORMATION AND LOCATION
3�OO �ry+e n- �- -. Gl Each additional 500 sq. ft.or portion
Job site address: ' _I r I _ thereof $ 27.50 $ 1
City: Str)Yl c11U 1 State:3?_ I ZIP:9'49 n Limited energy(2) $ 35.00 $ Y
Reference: 7 /5 3 a Taxlot.: OOO Each manufactured home or modular
$ 6900. $ t
0�r,�SCurdwelling service or feeder(2) (
DESCRIPTION OF WORK11--
�)(X Tf>r 'ft 5}] Services or feeders:installation.alteration,relocation
{P t^ �X1 reLY L� �V 1 TG 200 amps or less(2) $ 89.00 $
ittt'AIRS l 1
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
401 to 600 amps(2) $174.00
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Name: L L-�_...---_ .---- - }
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Address: �o`�C Z6/7 Sr 601 to 1,000 amps(2) $225.50 S
City: Arreilte Stater_ ZIP: INOZ Over 1,000 amps or volts(2) $516.00 S ?
Phone: - - Fax: - - Reconnect only(2) $ 69.00 S
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E-mail: Temporary services or feeders: imtallatlai, alteration. relocation
200 amps or less(2) I $
This installation is being made on residential or farm property 69.00 $!o
owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 96.00 $
properly is not intended for sale,exchange, lease,or rent.OAR '
479.540(I)and 479.560(1). 401 to 600 amps(2)_--_ $138.50 $ I
Signature:
Over 600 amps or 1.000 volts,see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:new alteration.extension per panel
Business name: Eta j f ri G)I V� a.Fee for branch circuits with purchase of a service or feeder fee: i
Address:3LI 531 i1 w 9 5 p Each branch circuit 1 tJ S 6.50 r$ t�
City: ' .Vy�d _I I State:06Z ZIP:4332-J QS b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:911?Z C Fax:S-r! 1311)3 First branch circuit(2) —I $ 60.50 $ I
E-mail: -11 L•i.ytt7� tit-2 &. Each additional branch circuit $ 6.50 $ I
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n o.: 1 D) BCD license no.:2n_3236 Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 40S Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: �_ Each sign or outline lighting(2) $ 69.00 $
/ - Signal circuit or a limited-energy panel,
Signature of signing supervisor- - ly3� alteration,or estcnsion(2) $ 80.00 $
_• -..., + _ _
Each additional inspection:(I) $80.00 $------
APPLICANT USE
(A) Enter subtotal of above fees 'Q
(Minimum Permit Fee$80.00) $O� '
(B)Enter 12%surcharge(.12 x[Al) $ 94
(C)Technology Fee(5%of[Al) $ 1/,10
440-2584-1(4l0I(2013/COM) TOTAL fees and surcharges(A through C): $ 15 Mg 1
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SPRINGFIELD- - CITY OF SPRINGFIELD
TRANSACTION RECEIPT Sp�gfield,OR97477
''" OREGON 541-726-3753
811-SPR2013-00723
www.spnngfeld-or.gov 3800 INTERNATIONAL CT permitcenter @springfield-or.gov
RECEIPT NO: 2013000713 RECORD NO: 811-SPR2013-00723 DATE:04/11/2013
WESORIPTION • '_- ACCOUNT CODE/TRANS CODE Y AMOUNT DUE
Branch circuits with service or feeder each circuit 224-00000-426102 1004 13.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
Temp services 200 amps or less 224-00000-426102 • 1003 69.00
TOTAL DUE: 95.94
I PAYMENT TYPE 'PAYOR `CASHIER:CCARPENTER COMMENTS AMOUNT PAID';
Credit Card LANTZ ELECTRIC INC 95.94 __...-
035427
TOTAL PAID: 95.94
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The materials availab - at this web site are for informational purposes oonly and do not constitute a legal document.
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