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HomeMy WebLinkAboutPermit Electrical 2013-5-21 EleCtI1Cal Permit Application .PRI■o.Ie..o DEPARTMENT USE ONLY CITY OF SPRINGFIELD, OREGON Permit S/3-o I ° o S • 225 Fifth Street•Sprin�eld,OR 97477•PH(541)726-3753•FAX(541)726-3689 - • Date: ' 0 lA q • 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 O Qty. Cost Total CATEGORY OF CONSTRUCTION Residential,per unit,service included: ❑Residential ❑Government Commercial 1.000 sq.ft.or less(4) $134.00 $ JOB SITE INFORMATION AND LOCATION / Each additional 500 sq.ft.or portion Job site address: y233 1/iceIY) SI- thereof $ 25.00 $ City: Spn ,k' la( State: 0Q ZIP: ' /yZb Limited energy(2) . $ 32.00 $ . Reference: /70 Z 3 Z 3 2.. Taxlot.: 01 ?00 Each manufactured home or modular DESCRIPTION OF WORK dwelling service or feeder(2) $ 63.00 $ • Add "w� bar /-r I..,, . exi. / Services or feeders:installation,alteration,relocation / (u.vt GJr/ CGOt.er- �7 r/ 'P ,200 amps or less(2) $ 81.00• $ t'C�-F ilv.,2 � - card- . PROPERTY OWNER 201 to 400 amps(2) $ 95.00 $ Name: C/'y t- c Sly n�la.c-I-. � 401 to 600 amps(2) $158.00 $ Address: y��0 Wain S+ Bic(5 17 Sje. 660 601 to 1,000 amps(2) $205.00 $ City: S Pnv'9--`e(c. State:� ZIP: q--N73 Over 1,000 amps or volts(2) $469.00 $ Phone[ -51�-O PJ°J� I Fax: - - Reconnect only(2) $ 63.00 $ E-mail: Temporary services or feeders: installation,alteration, relocation This installation is being made on residential or farm property - 200 amps or less(2) $ 63.00 s owned'by me or a member of my immediate family.This 201 to 400 amps(2) . $ 87.00 $ property is not intended for sale,exchange,lease,or rent.OAR 479,5400)and 479.560(1). 401 to 600 amps(2) $126.00 $ 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: ic_sdi S194 .r/j Awn � a.Fee for branch circuits with purchase of a service or feeder fee: Address: S''5 75 Pref.If 2 Rd( Each branch circuit $ 6.00 $ City: t1 LA_5e 0 2 I State: OR I ZIP: 971-1uZ b.Fee for branch circuits without purchase of a service or feeder fee: Phoned -q c- Ssw , I Fax.5il -WI s'b/3 First branch circuit(2) $ 55.00 $ E-mail: , J 0 loer-s.}Q ec as i3 t35. cove Each additional branch circuit $ 6.00 $ CCB license no.: 1673'-7 O I BCD license no.:205 LiS Ces Miscellaneous fees:service or feeder not included Signing supervisor's license no.: 574e 5/6y // . Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor: l tj /?osJor o Each sign or outline lighting(2) $G9 i00 $ (oc4 no Signature of signing supervisor: i Signal circuit or a limited-energy panel, $ 63.00 $ �1�� ..d 0 alteration,or extension(2) Each additional inspection:(I) $58.00 $ r� ' e� APPLICANT USE J V rfke es a S (`, (A) Enter subtotal of abov f es JS ` °� (Minimum Permit Fee $(vq• oo (B)Enter 12%surcharge(.12 x[A]) $ S. zr6 (C)Technology Fee(5%of[A]) $ 3,4S TOTAL fees and surcharges(A through C): $Sv,13 440-2584a(9t08/con) T36e SPRINGFIELD CITY OF SPRINGFIELD k7, �{ t� ',, TRANSACTION RECEIPT 225 FifeldtOR97477 iK '\OREGON 541-726-3753 811-S PR2013-01009 v. .wspringfield-o r.gov 4233 MAIN ST - permitcenter@spnngfield-or.gov RECEIPT NO: 2013001001 RECORD NO: 811-SPR2013.01009 DATE:05/21/2013 LDESCRIETI_ON ,. , ow, ,__... ACCOUNT_CODE/TRANSCODE „ h AMOUNT_DUE.`,j Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00_. State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 1.32 Technology fee(5%of permit total) 100-00000-425605 2099 0.55 TOTAL DUE: 12.87 PAYMENT TYPE PAYOR CASHIER:DeowLser COMMENTS : - 7,.i '. AMOUNT PAID! , Check E S&A SIGN CORP 12.87 59207 TOTAL PAID: 12.87 SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St TRANSACTION RECEIPT Springfield,OR 97477 OREGON 541-726-3753 811-SPR2013-01009 www.springfield-or.gov 4233 MAIN ST permitcenter@spnrigfield-or.gov RECEIPT NO: 2013001000 RECORD NO:811-SPR2013-01009 DATE:05/21/2013 LPEsditlii-tloi ---------7.-riT .-.--L---7,----- 1---.,.,,..-.:-?-' ; t-co-bErrtiAlibbE --,- -.----7 --.AMOUNT au EL..,.J Permit Fee Adjustment-Electrical 224-00000-426102 1004 69.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 8.28 Technology fee(5%of permit total) 100-00000-425605 2099 3.45 TOTAL DUE: 80.73 LPAYMENUYPE , ' .PAYOR. .CASHIER:liedwisthy :. it' - COMMENTS i-3- ::•:1::/; . , ,-,IyAMOUNT PAID' '... `.::.-'":°• ':41 Check ES&A SIGN CORP 80.73 59207 TOTAL PAID: 80.73 •