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HomeMy WebLinkAboutPermit Electrical 2013-4- Electrical Permit Application DEPARTMENT USE ONLY [� z. x--7-- . - - :.. F"° .x- B6 w - •1 SPRINGFIELD_. 5fZ^O Z3S O ! ?CITY:OE SPRINGFFEED, OREGON . { ( Permitnc54 3 -00 I 225 Fifth Street•Springfield,OR 97477k PR(541)726-3733♦F.0X(341)726-3689 1� K OREGON /3� 3 t Date: i 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 180 days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. east Total CATEGORY OF CONSTRUCTION ,_,,� Residential,per unit,service included: �r residential I ❑Government I ❑Commercial JOB SITE INFORMATION AND LOCATION 000 sq.R.or less(4) $147.50 $ /y/ J.�--- S J-- Each additional 500 sq.ft.or portion / $ 27.50 $ 77re j lob site address: Se S_-in 4— S / thereof I City: S O rt I State:OIL ZIP: 9.74/75 Limited energy(2) $ 35.00 $ p Reference: 17DZ 33Z 3 Taxlot.:O34O0 Each manufactured home or modular $ 69.00 $ II dwelling service or feeder(2) DESCRIPTION OF WORK I HS CJ L✓f -C Services or feeders:installation,alteration,relocation •K 200 amps or less(2) $ 89.00 $ PROPERTY OWNER 201 to 4400 amps(2) $ 104.50. S Name: 3 5 pM•Ire- F.80L -i-!vV r '"-Y"0 amps(2) $174.00 $ Address: 9/6 lMta2epl...¢ 601 to 1.000 amps(2) $225.50 S City: <An I State:0 2_ I ZIP:: 7y7g Over 1,000 amps or volts(2) $516.00 $ Reconnect only(2) $ 69.00. $ Phone: - - I Fax: - - E-mail: Temporary services or feeders:installation, alteration, relocation. This installation is being made on residential or farm property 200 amps or less(2) $ 69.00 $ owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 $ property is not intended for sale,exchange,lease,or rent.OAR E 479540(1)and 479.560(1). 401 to 600 amps(2) $13a.6o $ f Signature: Over am O 600 amps or 1,000 volts.see services or feeders section above p' CONTRACTOR INSTALLATION q Branch circuits: nett,alteration,extension per panel r Business name: /7 /e)1) 1 CO a/L C /K/ C a.Fee for branch circuits with purchase of a service or feeder fee: ti Q Address: ,g 6 /6 3 -7 • Each branch circuit $ 6.50 $ I City: Ignieylita State: ZIP: rf 7 , $`Jl., "or branch circuits without purchase of a service or feeder fee: Phoney26- o 3 Fa.vj-el/ . -q/.s-2 S=2 2p-it, rt `ftlyt3tx(�uf;ch circuit 2 E-mail: \9/- rP 0 ate branch circuit $ 6.50 $ I CCB license no.: ?Y Cs- BCD license e O� v JS Q 'p`• ,uOr us fees:service or feeder not included• se ai <r r Signing supervisor's license no.: • f�°''• t �Xv -0 50 s' fit 'Cr' nrigation circle(2) $ 69.00 $ Print name of signing supervise' ...41.. . a.p ei r e 1o�1`\ O° E.S �Lnn or outline lighting(2) $ 69.00 $ // ' p'0 \ . \ jg"��coca it or a limited-energy panel, I Signature of signing supervisor. Air ..- c• P ` O $ 80.00 $ Nit' _ J G 0 O rra'3 aeration,or extension 2 l \r0�•�e ire lre0z�$� Each additional inspection:(1) $80.00 $ Ii O°Gee'ctoesGec AP JT USE C 'OS �' (A) Enter subtgtVc ve e of $ 7,`/ (Mliniprafl4i?p,,```CC100 n I / / \xo'(\c't� i s ptetc sdrylis9��.NPYIAD $ 2/ M IN U1V° IOS��ear�t IN _ee(5%of IAD $ g 7de 440-2584-1(4/01/2013/COM) le,. „et() a}, (4�•esandsurcharges(AthroughC): $m^1( 73 VPN��"\% NI ` SS����»" Cam✓ SPRINGFIELD CITY OF SPRINGFIELD _�*�` 225 Fifth St `O EGON TRANSACTION RECEIPT Springfeld,OR 97477 541-7263753 811-SPR2012-02380 www.springfield-ar.gov 580 51ST ST permitcenter©springfield-or.gov RECEIPT NO: 2013000839 RECORD NO:811 SPR2012-02380 DATE:04/30/2013 D • ON - - IT\aL: ;* «ate='* _ .',:`;.. _a121.y_.;,;ACCOUNT CODE/TRANS CODE 3fiAte j•i 'AMOUNT DUE Bi=z Each added 500 sq.ft. or portion 224-00000-426102 1004 27.50 Residence wiring 1,000 sq. ft. or less 224-00000-426102 1004 147.50 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 21.00 Technology fee(5%of permit total) 100-00000-425605 2099 8.75 TOTAL DUE: 204.75 treP.AYMENIT'P.E -_*,W PAY,OR cASRIERposorilisR F COMMENTS i ANIOUNTIP,AIDS" Check J SMITH REAL INVESTMENTS LLC 204.75 1440 TOTAL PAID: 204.75 •