HomeMy WebLinkAboutPermit Electrical 2014-3-22 MAR-26-2014 09:07 From:COMFORT FLOW HEATING 15419889954 To:5417263689 P.2'2
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Electrical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD 9V--CC 6ti r
CITY OF SPRINGFIELD, OREGON �►.�� permit no.: Sty •
225 Finn Slrcet•S ria�dJ,OR 97477•YH 5a171637S3•FAX 511726.3669
P 1 1 FAX(541)726.3689 ea•aort a/Z Z /�(
Date:
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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 or Inspections per item() Qty. Cost Total
--. .. ea. cost
CATEGORY OF CONSTRUCTION •
Residential,per unit,service included:
❑Residential ❑Government .: Commercial
JOB SITE INFORMATION AND LOCATION 1,000 sq.fl.or less(q) S147.50 s
-
Job site address: jiWIIIIIIMIIII Each additional 500 sq.ft.or portion
thereof $ 27.60 $
______ �� ZIP: �1 1� Limited energy(2) $ 35.00 $
LiEEnr1� Tax(ol.: Each mnmufuclured home or modular
`7 SCRIPTION OF WORK dwelling service or feeder(2) $ 69.00 $ -
Services or feeders:In tallatinn,alteration,retrralian
Y � I a ` /1
CA ,a a- 200 amps or less(2) $ 89.00 $
PROPERTY 0 NER f v .gs rt 20t to 400 amps(2) $ 104.60 $
_ ' 11. 401 to 600 amps(2) $174.00 .$
Address: I 601 to 1,000 wraps(2) $225.50 $ .
• a a • � �� ,‘,' •r was• Over 1,000 amps or volts(2) $916.00 $
Reconnect only(2) $ 69.00 $
,e Fax: -E-mail: -
-- �, 6 s to Temporary services or feeders: tnstallatian, alteration, relocation
This insia L ton is being made .n rest ntial or farm p b.erty 200 amps or less(2) S 69.00 s
owned by me or a member of my immediate family. This 201 to 400 amps(2) 6 96.00 $
property is not intended for sale.exchange,lease,or rent.OAR
47.9.540(1)and 479.560(1). 401 to 600 amps(2) $136.60 $
Signature: A 1 t 4' 3 0 I Over 600 amps or 1,000 volts,see services or feeders section above
r. ■ : • A • c Branch circuits: new, alteration,extension per panel
_ Llit a a.Fee for branch circuits with purchase of a service or fccdcr fee:
Address: It 5 1b ev\ , Each branch circuit l $ 6.50 ]. $
elligaMMIIIIESMEIZMUIb. Fee for branch circuits without purchase of a service or fccdcr fee:
�Phone: aggit - �O i O Fax:-M -• •y. _.- - 1 First branch circuit(2) S 60.60 $
l�ia�l� _ 4 sumo I 1 Each additional brunch circuit $ 6.60 $ '
,MMI BCD license no._ Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: 1 1 Jac Each pump or irrigation circle(2) $ 69,00 $
Print name of signing supervisor: S Lo ft 0 Each sign or outline lighting(2) $ 69,00 5
Signature of signing Supervisor: Signet circuit or a limited-euergy panel, $ 00,00 sqq,,
Y,n g g P alteration,or extension(2) I UO—
wires you to Each additional inspection:(1) 560.00 $ t
ATTENTION: Oregon law feOregon Utility APPLICANT USE
follow rules adopted by the (A) tinier subtotal of above fees _
Notification
Center. Those rut e0Afl 952%001 OD—
(Minimum Permit Fee$30.00) $ �b
In OAR 952-001-0010 throngs of the rules by.
(B)Enter 12% (.12 x(A)) 5
0090. You may obtainNote: the telephone RIB
the center. l (C)TcctmologylEcc(6%oflAf)
calling oft Utility Notiftcation oe,JI ��YX014E 1F THE y4C1 V
n ao:lsa4 n[n� t4IPtlie,Oreg YUTALIfeet 4odl�saticahF' - �rf� g
U nilT IST D
Center is 1-800 332 23441• AUTHORILtU UNDE I I p
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
LORE oN TRANSACTION RECEIPT S5Fifthld,oRS7477
541-726-3753
. 811-SPR2014-00645
www.springfieldocgov 225 5TH ST permitcenter(Kgspringfield-or.gov
RECEIPT NO: 2014000662 RECORD NO: 811-SPR2014-00645 DATE:03/27/2014
[DESCRIPTION
_ I 1,._,_ :f, 7re ".a*: "ACCOUNTCQDE/TRAN "CODE .; . ` `1AMOUNTDUE';`:
Signal circuit(s)or limited-energy panel, alteration, or extension 224-00000-426102 1004 80.00
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
PAYMENT_TYPE �; PAYOR ,CASHIER:beowLSev <.`" , , COMENTS `i: °AMOUNT PAID. 4:1
Credit Card Noel 93.60
04669J
TOTAL PAID: 93.60
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