HomeMy WebLinkAboutPermit Electrical 2013-8-19 Electrical Permit Application DEPARTMENT USE ONLY
yu�{y SPRINGFlELO ' .. �
ECI+TVOF SPR ,GE EED;OREG61 Permit no.: SI 3 'D18gjr
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225 Fifth Street•springfield,OR 97477♦PR(541)726-3753•FAX(541)726-3689
Date: / F
1703 27`13
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.
5 ti: ,<.' ,::'LOCAL; GOVERNMENTzARPROVAL,-= '#:'„„ ?,,, Y,s Ixi:?. t FEEJSCHEDULEW,Wi W5:;l
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Zoning approval verified? Yes No � r *c t t '''14 x#tCost Total--'
g PP ❑ ❑ Number of tt1fl!tons per3ttem O Qty ' 'eea l'''' eost,'4f
CATEGORY�OF r,CONSTRUCTION wt ”' '. a .-s: ,.x,._ .,__
. Y*fi..� .. s..t'`F'
Residential,per unit,service included:
❑ Residential ❑Government III-Commercial
;Yas' JOB'SITE,:INFORMATION'-AND'<LOCATIO ;`f Gt,3 1,000 sq. ft. or less(4) $147.50 $
S S-5 • / Each additional 500 sq. ft.or portion
Job site address:
4ZV-....A thereof $ 27.50 $
City: S P F F State: 04_ ZIP: 7 7y 77 Limited energy(2) $ 35.00 $
Reference:17 0 3 37 C( 3 Taxlot.Qs$-O'7 Each manufactured home or modular $ 69.00 $
,:rs-r a ,- y s �. ;%- dwelling service or feeder(2)
.`.Sv U...� 3 .„::�SDESCRIPTION;„.OF�..WORK�,,, ,. .,$�$O�' _
�o� Services or feeders: installation, alteration, relocation
D o writ a O A. pEa 200 amps or less(2) $ 89.00 1
n sc. G'44v1 pates
't' * ”>;,T, ; ., P.ROPERT't.OWNS ;;;: ,. . !.:' ,• x 201 to 400 amps(2) $ 104.50 $
Name: �'er,-.4'' f Liras Grp_ Li-C._ 401 to 600 amps(2) $174.00 $
Address: 7f 3 1 $T k4c_ 57Ls (03 601 to 1,000 amps(2) $225.50 $
City: /' State: OIL ZIP: 172 r 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 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
'kt#, 't_ iC-ONTRACT.,OR`,,INSTALLATION s..y !g44% Branch circuits:new alteration, extension per panel
Business name: 4 TE_tj ee[irree G a. Fee for branch circuits with purchase of a service or feeder fee:
Address: .O . 'J�01e 1 (1 3� Each branch circuit 5 6.50 $
City: t C- L4 1e..g State:Qg. ZIP: /7 V y0 b.Fee for branch circuits without purchase of a service or feeder fee:
Phonect{( 4-11- Q 7'76 Fax: - - First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: 547yB BCD license no.:ZO--2-51C. Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 3 55 3.�' Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor;:,,,, - ),°, rg Each sign or outline lighting(2) $ 69.00 $
rh Y;, ,.,t6'•
eft°" °9" Signal circuit or a limited-energy panel,
Signature ��ipev 8:b tt $ 80.00 $
A� � ad-1' u y "s alteration,or extension(2) .
10110W rules ter. o tp o b OAR TtJ\tS b
N°tifi°ation center. 0 UV° 9 °t the rules Y Each additional inspection:(I) I $eo 00 $
in OAR 952Dat n01_0010 telerf.,n' s447A t APPLICANT USES ,... .. . = x t
the L 3 -:
0o9all Re{e t e Ot e(3" 332,2 oto car,° (A) Enter subtotal of above fees . $ 4
U Minimum Permit Fee$80.00
b center is t"$0 4t D� 6
nUu i (B)Enter 12% µtab kiel 1
\\ o16 clieC)s t� "NCO/4R $ y C
1�DP1 �1�1� teso $1t1Q�iaFeges(A through C): $ V� 13
coWll*0 DAY PER10D• I
440-2584-3(4/012013/COM) APN
SPRINGFIELD ` CITY OF SPRINGFIELD
225 Fifth St
t''R'E�oN TRANSACTION RECEIPT Springfield,OR97477
541-726-3753
• 811-SPR2013-01845
www.springfieldor.gov 555 W CENTENNIAL BLVD permitcenter @springfield-or.gov
RECEIPT NO: 2013001798 RECORD NO:811-SPR2013-01845 DATE:08/19/2013
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DESCRIPiION��,x" � �> ..-��u<aa..:_�-_�;� =�''AGCOUNTCODE/TRANS.CODE'�.,;�+? ±..,a:"AMOUNT�DUE a;
Services 200 amps or less 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.68
Technology fee(5%of permit total) 100-00000-425605 2099 4.45
TOTAL DUE: 104.13
P„�AYMENTaTYP.E Z PAYOR- cgs i Deouu ar _ COMMENTS AMOUNTJPAIU"_'
Check lite electric service 104.13
7551
TOTAL PAID: 104.13