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HomeMy WebLinkAboutPermit Electrical 2013-10-7r Electrical Permit Application naamarrrt.D DEPARTMENT USE ONLY • CITY OF SPRINGFIELD, OREGON ` I Per,,ilna-; �1I ze,l 3 ot45� 225 Fifth Street♦Springfield,OR 97477ePII(541)726-3753♦FAX(541)726-3689 u Date: /a/7 / // 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 ea. - cost CATEGORY OF CONSTRUCTION Residential,per unit,service included: ❑Residential ❑Government ❑Commercial 4f7� a •JOB SITE-INFORMATION' AND LOCATION 1,000 sq.B.or less(4) 7 $(t{� I f Q / (Acid d Each additional 500 sq.ft.or portion {�/ $ 2 S- lob site address: U ( eXM thereof a-�V L City: State: ZIP: Limited energy(2) $ 32.00 $ Reference: Taxlot.: Each manufactured home or modular $ 63.00 $ DESCRIPT ON OF WORK Services service feeders:feeder(2) Services or feeders:installation,alteration,relocation 20000 a ess-(2) 61.00 $ . PROPERTY OWNER 201 to 400 amps(2) $ 95.00 $ Name: _.,,_,i Oc Ls L c e- 401 to 600 amps(2) $158.00 $ • Address: Pb , 2 6 Zc'S 601 to 1,000 amps(2) $205.00 $ City: f-2 G-r e I State:O, I ZIP:1 7 y7/ Over 1,000 amps or volts(2) $469.00 $ Phone: - - I Fax: - - Reconnect only(2) $ 63.00 $ E-mail: Temporary services or feeders:installation,alteratjpr,relocation This installation is being made on residential or farm property 200 amps or less(2) / $ 6340T $ 697 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 479.5400)and 479.560(1). 401 to 600 amps(2) $126.00 $ Signature: Over 600 amps or 1.000 volts,see services or feeders section above CONTRACTOR INSTALLATION S),_L Branch circuits:new,alteration,extension per panel Business name:'ll) IIt%t ptilim)C..---/l�il GLI'dI IG a.Fee for branch circuits with purchase of a service or feeder fee: Address: ` �� Le (cL fe Each branch circuit $ 6.00 $ City: State:opf/,///Z1 P/9ll 02`a77 b.Fee for branch circuits without purchase of a service or feeder fee: Phone �pf 03 p (� Q /,' Fanx, cont./470/t _t C7 l/ptt First branch circuit(2) $ 55.00 $ • E-mail ) W/1p��J YXttT/ ' , Each additional branch circuit $ 6.00 $ CCB license no.:/'j48/31 BCD license no.as-3/7C, Miscellaneous fees:service orfeeder not included Signing supervisor's license no.: Atli P /oqS ,// Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor:7m ri-;n , /r - 6-ra Each sign or outline lighting(2) $ 63.00 $ Signature of signing su e[vI5o1C Signal circuit or a limited-energy panel, $ 63.00 $ g g g p ...ter n ^ ' \ alteration,or extension(2) V�' / Each additional inspection:(I) $58.00 $ (A) Enter subtotal of above fees $ (Minimum Permit Fee$58.00) (B)Enter 12%surcharge(.12 x[Al) $ (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through C): ‘5:15-`1( 440-2584-1(9/OS/COM) SPRINGFIELD CITY OF SPRINGFIELD 1 :,�... 225 Fifth St rr`C+„ TRANSACTION RECEIPT 3pringfeld,OR97477 .OREGON 541-726-3753 811-SPR2013-01458 www.springfietdor goy 4180 Glacier View DR 4182 permitcenter @springfield-or.gov RECEIPT NO: 2013001856 RECORD NO: 811-SPR2013-01458 DATE:08/23/2013 LESCRIPTION - „ ' ' „ . ACCOUNT CODE/TRANS CODE 'AMOUNT DUE;°J Each added 500 sq.ft. or portion 224-00000-426102 1004 82.50 Residence wiring 1,000 sq. ft. or less 224-00000-426102 1004 147.50 Services 200 amps or less 224-00000-426102 1004 178.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 57.24 Technology fee(5%of permit total) 100-00000-425605 2099 23.85 Temp services 200 amps or less 224-00000-426102 1003 69.00 .---__ TOTAL DUE: 558.09 I'' PAYMENT TYPE ^ PAYOR°,,cnsRleREuuRSON, ..° . COMMENTS =-,. ., ',,,„1 - "AMOUNT.PAID"„ ,2 ,,j Check MIKE GANSEN CONSTRUCTION 558.09 023873 COMPANY . TOTAL PAID: 558.09 • • •