HomeMy WebLinkAboutPermit Electrical 2014-1-28 1
Electrical Permit Application DEPARTMENT USE ONLY
t a '4 h n's;. ✓• tr.g .r. - SPRINGFIELD ��
SOF SPRl @FEEibi ®RGCONt' 1-- 00 7
' rn ...-,. ,: �.?,E•ui ,,.. �:�. .:c.- Permit na:
225 Fifth Steet4S ant 0eid,OR 974774 rli 541 726-375341 xX 541 72G 3689 tom
i g ( ) ( ) OREGON /?1 /�
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.
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? W Yes ❑No Number of inspections per item Qty. Cost Total
1 P () Q > ea. cost
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
Residential ❑Government ❑Commercial
1.000 sq.R.or Icss(4) I $147.50 $/y 7.a-u
JOB SITE INFORMATION AND LOCATION Each additional 500 sq. it.or portion
Job site address: /4(b'3 let ins¢
/ • thereof 6 $ 27.60 $/g.J^—
City: ..f r-N. _ State: - ZIP: 7q 77 Limited energy(2) $ 35.00 $
Reference: O 6 3 ZL 33 Taxlot.O J gc7O Each manufactured home or modular $ 69.00 $
DESCRIPTION OF WORK dwelling service or feeder(2)
Services or feeders:installation,alma:Hon,relocation
Aft-4 stiJ 200 amps or less(2) $ 89.00 $
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
y 401 to 600 amps(2) $174.00 $
Name: ice if/a.�5Lti1\- Yl
Address: I Liz 3. e j rots 601 to 1,000 amps(2) $225.50 $
City: s r.6 StateCXL, ZIP: 7V77 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 S
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 S
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:nerr,alteration,extension per panel
Business name:_7,,,," 4„.„, e [er a a. Fee for branch circuits with purchase of a service or feeder fee:
Address: /1. O. (3a k 7 3yZ Each branch circuit I $ 6.50 $
City: 5,454.yf-f State:cne ZIP:773 pJ h.Fee for branch circuits without purchase of a service or feeder fee:
Phone: Su,J 7'J 2223 Fax: 6-21'3 3 73-?72z First branch circuit(2) $ 60.50 $
E-mail: Each additional branch circuit $ 6.50 $
CCB license no.: / /7 /2,/ BCD license no.: 2..54-5d-q Miscellaneous fees:service orrfeeder not included
Signing supervisor's license no.: yJ/ f Each pump or irrigation circle(2) - ! $ 69.00 $
Print name of signing supervisor: Oct /d.'wt!1 finch sign or outline lighting(2) $ 69.00 $
Signature of signing sn ervisor:,i-- Signal circuit or alimited-energy panel, $ 80.00 $
S g P alteration,or extension(2)
Each additional inspection:(I) $80.00 $
'(1783-38E-00e-L s! JeTua° APPLICANT USE
uopeogpoN Aprijo uo6aa0 all ao).iogwnu (A) Enter subtotal of above fees
auold819l all :aloN) •taloa° all 6u111eo
(Minimum Permit Fee$80.00) $3ii
Aq soma all to Se doo u!elgo Aew noA '0600 (B)Enter 12%surcharge(.12 x[Aj) $3 7.,711
-L00- G6 aV0 46noal+0)00-)00-2,96 BVO 01 (C)Technology Fee(5°' or[A]) $/3--6S
two'las 0JB sem)°sou 'igloo° uo!leogpoN
44o-2;1) 4(o1/ )3(coM) l Aq peldope saln4 mono! TOTAL fees and surcharges(A through C): $ 3 6 • 63
of noA sed!nbaa me' uobeJO NOI!N311V
NOTICE: . .•
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spnngfield,OR 97477
`O REGON 541-726-3753
811-SPR2014-00171
www.springfield-or.gov 1483 DELROSE AVE - permitcenter @spnngfield-or.gov
RECEIPT NO: 2014000179 RECORD NO:811-SPR2014-00171 DATE:01/28/2014
DESCRIPTION u2: _ fix - 2-_ � 5n� � P - '`ACCOUNT COD TRANS CODE.t3Y` AMOUNTOIIIV'H
Each added 500 sq.ft. or portion 224-00000-426102 1004 - 165.00
Residence wiring 1,000 sq.ft. or less . 224-00000-426102 1004 - 147:50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 37.50
Technology fee(5%of permit total) 100-00000-425605 2099 15.63
TOTAL DUE: 365.63
PAYMENT TYPE PAYS AR[ CASHIER� BOswi COMMENTS . ?MOUNTitPAP
Credit Card INTERSTATE ELECTRIC INC 365.63
06551g
•
TOTAL PAID: 365.63