HomeMy WebLinkAboutPermit Electrical 2013-5-24 . 1111
Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
CITY OF SPRINGFIELD, OREGON t � Permitno.: 23 O O 6Z i
225 Fifth Street•S rin field,OR 97477+P6541726-3753,FAX(541)726-3689 �r\a
P g ( ) \OREGON D
Date: S/y /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. east Total
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
Residential I ❑Government I ❑Commercial
JOB SITE INFORMATION AND LOCATION 1,000 sq. ft.or less(4) $147.50 $
AA Each additional 500 sq.ft.or portion $ 27.50 $
Job site address: 2.S 14140 C- . thereof
City: �t0.s`e-tl'� State:Ott_ ZIP:1?179 Limited energy(2) $ 35.00 $
Reference: '703ZZt-( ( Taxlot.:QO POO Each manufactured home or modular $ 69.00 $
DESCRIPTION O 'WOR,IQ�'U./ G. dwelling service or feeder(2)
frsit-v F 000 A i AFC_ * 2 Ct' 44 k Services or feeders:installation,alteration,relocation
L/ 200 amps or less(2) ( $ 89.00 $ 04°2-,
PROPERTY OWN Ili 201 to 400 amps(2) $ 104.50 $
. Name: -r(t,b7t/ TY\J ( -CT 401 to 600 amps(2) $174.00 $
Address: Z_s /[ -1-- 601 to 1,000 amps(2) $225.50 $
City: f cQ.k. State:0C I ZIP:ark-7? Over 1,000 amps or volts(2) $516.00 $
i
Phone: I Fax: - - Reconnect only(2) $ 69.00 $
E-mail: Temporary services or feeders:installation,alteration, relocation
This installation is being made on residential or farm property 200 amps or less(2) $ 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
479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:near,alteration.extension per panel
Business name: fja((/.{p„` (Ad full C • a.Fee for branch circuits with purchase of a service or feeder fee:
Address: e 0 box `' (00- 1 Each branch circuit [ gel $ 6.50 I $ '
City: gJA�..�. State: 041-- ZIP:9?s(o4 b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:$"((- -2) —? - Get_50 I Fax: J.O - First branch circuit(2) $ 60.50 $
.0L' Each additional branch circuit $ 6.50 $
E-mail: yo pP,,,,.sy . ci
1 (0_,..\0. c) f M Miscellaneous fees:service or feeder not iachnled '
CCB license no.: \Ft443a-at ,� 56) 4 76 t.
<.. CS , .c, .�- .
0 \ Each pump or irrigation circle(2) $ 69.00 $
Signing supervisor's lic,,,�4 lr J\ ?7G'�Uv _
•xo �"tit t(t� \.,,X,Cit'"`�' 1:..;.:r.:.:-$:.,
Print name of c' : ��p- .s '�•-•c: r J Each sign or outline lighting(2) 69 0 $
Si natu 'a '," -�a ;GOB', ,�t it Signal circuit or a limited-energy panel,; '` -$
g i :yam- � f9- alteration,or extension-(2) - .. c-,`.4 -�x���e�y U`,"per"4,0. 11/40 4\0 32 el cteOte9 � Each additional inspection:APPLII) �" �� ' 0 $"
,tio
ooy e \re s\' \'' O
• �09�;�`petGep\etx ((Minim.kiktt .e*a\`t" �J 1\V`v $ /0 1/ i
(B)*�PJrr"\,,�`�"��tilip ikayS4 0• $ /z.14
(C)TeNhigb'g,�Ft p(IIt11T $ 5-./0
440-2584-1(4/01/2013/COM) TOTAL,tcJ. niO�'Chia�arrges(A through C): $ H i )3'
P Hi
C-77 1
SPRINGFIELD CITY OF SPRINGFIELD
Wiz-- 225 Fifth St
etti TRANSACTION RECEIPT Springfield,OR 97477
.OREGON 541-726-3753
811-SPR2013-01062
www.springfield-or.gov 25 ANN CT permitcenter @springfieId-or.gov
RECEIPT NO: 2013001036 RECORD NO: 811-SPR2013-01062 DATE:05/24/2013
(DESCRIPTION' ° ,,L__,,,_..,.___ AC000NT CODE/TRANS CODE-- C. 't,AMOUNT DOE-Li
Branch circuits with service or feeder each circuit 224-00000-426102 1004 13.00
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 12.24
Technology fee(5%of permit total) 100-00000-425605 2099 5.10
TOTAL DUE: 119.34
LPAYMENT TYPE - - PAYOR CASHIER:oeowser` .. „•_,,,„„COMMENTSL �.-,;,.' ,, =`AMOUNT PAID ?