HomeMy WebLinkAboutPermit Electrical 2013-5-21 Electrical Permit Application ,,, , , I
,„aMe3. DEPARTMENT USE ONLY
CITY OF SPRINGFIELD, OREGON Perna no.a/3 -6(0 ( 1.
225 Fifth Street•Spriagfeld,OR 97477•PH(541)726-3753•FAX(541)726-3689
Date: 5/Z03
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 121Commercial 1,000 sq.ft.or less(4) $134.00 $
,0 J08 SITE INFORMATION AND LOCATION
8 Job site address: �j j� �N1 Each additional 500 sq.ft.or portion
�f��`d r 1.0.i✓1 S+. thereof $ 25.00 $
9 City: 5 prA^r\-i^e.[d State: (J✓(' ZIP: 91475 Limited energy(2) $ 32.00 '$
Reference: y-7o23LI 32- ' Taxlot.:c 360 Each manufactured home or modular
DESCRIPTION OF WORK dwelling service or feeder(2) $ 63.00 $
4dA J 1 nto n /,� rc/ - r- -Jo Pxts-/- B� Services or feeders:installation,alteration, relocation
-I��(p t UG(�(` (� 200 amps or less(2) $ 81.00 $
irt-0f/,ilrLa 011 Co I 'fie-e. Lar •--
PROPERTY OWNER 201 to 400 amps(2) S 95.00 $
Name: C.uric Stew cx r-* 401 to 600 amps(2) $158.00 $
Address: y/060 (y)S f 60,5 B si-• 66 D 601 to 1,000 amps(2) $205.00 $
City: 52614.3 Frei cl State: Oa ZIP: 91L/6 -Over 1,000 amps or volts(2) $469.00 $
J Reconnect only(2) $ 63.00 $
Phone:S{I Sll- rGbSYJ 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: Es rd A Sign d,��7I/�sln t`�o�/ a.Fee for branch circuits with purchase of a service or feeder fee:
Address: 9J ` 975- Prii if—;e t` 0t: `l Each branch circuit $ 6.00 $
City: k(.rCl.epl e_ State: Oy1 ZIP: 97102 b.Fee for branch circuits without purchase of a service or feeder fee:
Phones -1-155-l - ys- S5116 Fax:sl -ygS- SS) 3 First branch circuit(2) $ 55.00 $
a E-mail: 30 hers 4-e e Sesa 5 7,9 n S,c nyYl Each additional branch circuit $ 6.00 $
CCB license no.: /63LJ7 0 BCD license no.: 20943 C<-S Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: Si t f S(S . Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor: Gr r.cL!_ ,' '0 /.t—d Each sign or outline lighting(2) $ x.00 $614,0
�nJ Signal circuit or a limited-energy panel,
Signature of signing supervisor: �e- `2o }_,-0 $ 63.00 $
/ alteration,or extension(2)
Each additional inspection:(1) $58.00 $
APPLICANT USE
(A) Enter subtotal of above.F es $/
(Minimum Permit Fee %) b
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(B)Enter 12%surcharge(.12 x[A]) $ 8.2S
(C)Technology. Fee(5%of[A]) $ 3.45
TOTAL fees and surcharges(A through C): $ 00,13
5360
440-2584-J(9/08/COM)
SPRINGFIELD- CITY OF SPRINGFIELD
$ ,n“¢.. ,`" 226 fifth St
� ��, �� TRANSACTION RECEIPT Springield,OR97477
OREGON 541-726-3753
811-S P R2013-01011
ww.springfield-or.gov 5850 MAIN ST
vi permitcenter @springfield-or.gov
RECEIPT NO: 2013001004 RECORD NO:811-SPR2013.01011 DATE:05/21/2013
LDESCRIPTION ACCOUNT CQDEITRANS CODE_If , AMOUNT'DUE .;
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
(;,,PAYMENT TYPE_ PAYOR' -:.'CASHIER:DBOWLSBV ,v COMMENTS :' _ ', .;AMOUNT-PAID: :=;I
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Check E S&A SIGN CORP 93.60
59207
TOTAL PAID: 93.60
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