HomeMy WebLinkAboutPermit Electrical 2013-5-21 Electrical Permit Application SPRINGFIELD DEPARTMENT USE ONLY
CITY OF SPRINGFIELD, OREGON pertnirno.: S/3-0/0/0
225 Fifth Street•Springfield,OR 97477•PH(541)726-3753•FAX(541)726-3689
. . Date: SZ/ r 3
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, Cost Total
CATEGORY OF CONSTRUCTION ea. cost
Residential,per unit,service included:
❑Residential ❑Government 0 Commercial
JOB SITE INFORMATION AND LOCATION 1,000 sq.ft.or less(4) $134.00 $
Each additional 500 sq.ft.or portion $ 25.00 $
J lob site address: ZZZ 5+tt .4 //Sfr"a-t thereof
City: SprilAb �.`t,lc{ -7 State: vet ZIP: 9`747 / Limited energy(2) $ 32.00 $
Reference: 17633 5 J Z Taxlot.:DJ )0 O Each manufactured home or modular $ 63.00 $
DESCRIPTION OF WORK dwelling service or feeder(2)
iJ-a n ex!b Services or feeders: installation,alteration, relocation
vw 9 // CV'.._r_ l „ r&'47 Ca r� 200 amps or less(2) $ 81.00 $
t PROPERTY OWNER 201 to 400 amps(2) $ 95.00 $
Name: Chris Sk u.ntr.1- 401 to 600 amps(2) $158.00 $
Address: 2-Ko60 VYaLt;n se- 6149 8 Ste 660 601 to 1,000 amps(2) $205.00 $
City: S prtiV\l 'e.l d State: 08Q ZIP: `f71-1013 Over 1,000 amps or volts(2) $469.00 $
�]_ 17 SE5 Reconnect only(2) $ 63.00 $
Phone: $ 8 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) $ 63.00 $
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
479.540(1)and 479.5600). 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: L S 4 A- S,te)h ,.8 ytl a.Fee for branch circuits with purchase of a service or feeder fee:
Address: 09,-7 S Pr airn'e / / Each branch circuit $ 6.00 $
City:gc.11.P__rl e State: CA ZIP: 914-/OZ- b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:5J/ --'j - 552-46, Fax:54/-YE6 58/3 First branch circuit(2) $ 55.00 $
—' E-mail: 3 obe 31 eega5i v21 . CovA -Each additional branch circuit $ 6.00 $
CCB license no.: /10 3u 70 BCD license no.:20943 as Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: //��S/Y 5/e_ _ Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor: gar -LO /21ie bCa--0 Each sign or outline lighting(2) $(ey.00 $69 GO
. yJe Q � �J Signal circuit or a limited-energy panel, $ 63.00 $
Signature of signing supervisor:
.mil°'^'7 �O alteration,or extension(2)
Each additional inspection:(1) $58.00 $
APPLICANT USE
(A) Enter subtotal of ahoy fees 69.(Minimum Permit Fee_p p:!i0) $ . OJ
(B)Enter 12%surcharge(.12 x[A]) $ 9.y$
(C)Technology Fee(5%of[A]) $ 3'-I5
TOTAL fees and surcharges(A through C): 1 $ 80,13
93 6a
440-2584-I(9/08/COM)
SPiiiNGFIELD + CITY OF SPRINGFIELD
t? ..L-,- -4d`:—, 225 Fifth St
(fit - ., TRANSACTION RECEIPT Springfield,OR97477
gifit'"„1 OREGON 541-726-3753
811-SPR2013-01010
www.springfield-or.gov 222 S A ST permitcenter @springfield-or.gov
RECEIPT NO: 2013001002 RECORD NO: 811-SPR2013-01010 DATE:05/21/2013
4DESCRIPTION . „ ,, _. . ,ACCOUNT,CODE/TRANS_CODE ,x _.r . ;AMOUNT„DUE, ;f
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00
Sign or outline lighting 224-00000-426102 1037 69.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
LPAtMENT TYPE ',!PAYOR t,.'CASHIER:DBOWLSBY .°` , 'COMMENTS° : •'. - s+.AMOUNT..PAID-�, .,, ° ''
-Check E S&A SIGN CORP __-__.__ -- �- _ - 93.60mm
59207
TOTAL PAID: 93.60