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Permit Electrical 2013-6-11
Electrical Permit Application DEPARTMENT USE ONLY SPRINGFIELD CITY OF SPRINGFIELD OREGON Permit no.: S/3 a I Z(( S lir 225 Fifth Street•Springfeld,OR 97477.PH(541)726-3753FFAX(541)726-3689 to ���� \OREGON Date: 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. f LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Cost Total i CATEGORY OF CONSTRUCTION ea. cost Residential,per unit,service included: ❑Residential ❑Government I commercial JOB SITE INFORMATION AND LOCATION 1,000 sq.ft.or less(4) $147.50 $ Job site address: js.` Each additional 500 sq.ft.or portion $ 27.50 $ '4'7 S S 'j4v'-e.+-•'r thereof City: �'1fv4.•r+-(.2- State: Ot._ ZIP: 97477 Limited energy(2) $ 35.00 $ Reference: OU/703 a`BIZ I Taxlot.: 0120 ( Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) I Services or feeders:installation,alteration,relocation S-e.-.r.3•41.41.1 4 At VAA- Jot tie 200 amps or less(2) $ 89.00 $ PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $ 1 401 to 600 amps(2) $174.00 $Name: C,;.1.„4 7S .s((Q.Address: L Z ` 1JS �"pp 601 to 1,000 amps(2) $225.50 $ City: � 4 aQ State:Qt/_ -1 ZIP:477 Over 1,000 amps or volts(2) $516.00 $ Phone - 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 479.540(1)and 479.560(1). 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:nem; alteration,extension per panel Business name: p-e.A,l M a� , 4 e,,c a.Fee for branch circuits with purchase of a service or feeder fee: Address: P 0. 60K 6,1((02} Each branch circuit I $ 6.50 $ City: %. - II State: / ' ZIP: - b.Fee for branch circuits without purchase of a service or feeder fee: Phone: (- /e` Fax: - - First branch circuit(2) / $ 60.50 $ 610 CO fnkoei 6160 o,. .24,,•••a ,�r Each additional branch circuit $ 6.60 . $; 5^ E-mail: Q \ .0 (,. "3 Miscellaneous fees:service or feeder not included �r,'` ' CCBlicenseno.: 14��3� I � �t SSe�4F5` (o I 4 Signing supervisor's license gpc(a �, ace. .e 2-D O t1 y Each pump or irrigation circle(2) _ -. .stlibo(to st.,O•` r� Print name of signi • N.,/yQ�(e`, •►;'y„�e•�P (eg: Each sign or outline lighting(2) $�p .00'.( • gn _ 1",(+.t .r:1'!,�v..ax' . ,, f�V \\�� Signature is e\eP ' ,'o Signal circuit or a limited-energy panel, QI' lit C '" g Lr'iril ) ''En alteration,or extension(2) �`K\ Q.,\� to\0"��oa�g52p0a obea� 1�/ 30.b), Each additional inspe kr::°(11, %\\: �.� p...0T0 :1 N OPPVG.� Ge,• leg• 932 � ft'\\St 4\ �• Re w Qs.<�t\g`oot�`e�,2,0 (A) Enter subid't I b. '.;.t • \O0. o G. , GeP ( (Minimum Per <'��:I ,C,� .�� 12 $ 0— to, (B)Enter l2%surchar?'. 2<�0. ) ?et, $ grey (C)Technology Fee(5 S f[A]) '7 $ ; 440-2584-1(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ '1 0 S5- q36° SPRINGFIELD —- • CITY OF SPRINGFIELD .^h..., 225 Fifth St TRANSACTION RECEIPT Spdngfield,OR 97477 OREGON 541-726-3753 811-SPR2013-01248 www.springfieldocgav 1475 5TH ST permitcenter©springfield-or goy RECEIPT NO: 2013001208 RECORD NO:811SPR2013-01248 DATE:06/11/2013 hS .Ythil IdCo7`I x` __` ' ._ P :11. 1 aF-ta_x$_. ____--_:ACCOUNT-CODE/TRANS-CODE !-=T 5.;;;AMOUNT DUE `•'a Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 13.00 Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50 Branch circuits without service or feeder-each additional 224-00000-426102 1004 6.50 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 IrxrnY.MENTYpIYP,E BAY,ORg>LmCASHIER:JLARSOatr,. COMMENTS -._. _AMOUNT0PAID . Check BELLMAN GROUP INC 93.60 5592 TOTAL PAID: 93.60