HomeMy WebLinkAboutPermit Electrical 2014-2-21 •
Electrical Permit Application DEPARTMENT USE ONLY
t ' 2A:t. "gsr'. M¢Toix' e x , SPRiNGFtELD / o�
T O PRINGE ELD,k0REGON • - Permit no.: S/'I to 3 0
m - .�.e��: , sa if,An 2o.«,a.,, r,1.t '•.,)
225 Fi fth Street•Spnngfietd.OR 97477♦P11(541)726-3753*FA\(541)726-3689 "'S.OREGON t
.:s Date: 2/2 r//y
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 t
days of issuance or if work is suspended for 180 days. i
c
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? Yes ❑No Number of inspections per item() Qty. Ceoas t Total
cost
CATEGORY OF CONSTRUCTION
Residential,per unit,service included:
0 Residential ❑Government Commercial
JOB SITE INFORMATION AND LOCATION 000 sq.0.or less(4) $147.50 $
Each additional 500 sq. 0.or portion $ 27.50 $ )
Job site address: I trig- � �� a WIL B)u 6) thereof
City: S Ve ,ht,' J State: Oft ZiPP1-7(4157. Limited energy(2) $ 35.00 $ 1
1
Referent 1 1 $3 2 1 3 .Taxlot.00 O Each manufactured home or modular
$ 69.00 $ i
DESCRIPTION OF WORK dwelling service or feeder(2)
`c^S A. /1 1 `1 i 51�.� Services or feeders:installation,alteration,relocation f
�- 1 tnyvv,.,,q ,- trw� 200 amps or less(2) $ 89.00 $
tt
PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $
Name: R A-c_VES J Ur ((A,g / at 401 to 600 amps(2) —.-- $174.00---$ ;
Address: I R t. kAttiAl Sr ST. 70 p 601 to 1.000 amps(2) $225.50 S
A, Over 1,000 amps or volts 2 $516.00 $ t
City: vA
�+�Or►VIFi� State' .� ZIP: 9e46a _ ( )
Phone: - - /- Fax: - - Reconnect only(2) $ 69.00 5 •
E-mail: Temporary services or feeders:installation,alteration,relocation
This installation is . rig made on residential or farm property 200 amps or less(2) $ 69.00 $
owned by me or . member of my immediate family.This 201 to 400 amps(2) $ 96.00 $
property is no mended for sale,exchange,lease,or rent.OAR 1
479.5400 ad 479.5600). 401 to 600 amps(2) $138.50 $
Signa .re: Over 600 amps or 1,000 volts.see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits: new,alteration,extension per panel
Business name: F copit- s-b A 111;\rf a. Fce for branch circuits with purchase ofa service or feeder fee:
J U ¢
Address: /99—i S Ira or l' W---cf Each branch circuit $ 6.50 $
City: el^ State: QC__- ZIP: q-p 10- . b.Fee for branch circuits without purchase of a service or feeder fee:
Phone:,Syl- cs 5-Sy C Fax:SOJf yes 57;13 First branch circuit(2) • ' S 5p0�.6p( $ i
E-mail: o Each additional branch circuit . L�f 5• 1 $ :
��irJ k �2SaS,-5,r\s, co.,.— 'n•Vi.
CCB license no.:(( fl(� BCD license no.: 2'l—S43 CLS tMiscelani ous ffge Se/�jck. -[�yergr,r( t (�1r}!v�'eA^ry'��
�u -Each; n]ta'r"i' t'ot SEore r , C EL %`G$. $
Signing supervisor's license no.: �(H sic 2&!SL p p L � bht\� )h oo name of signinpervisor: r .h;,.s E lnl Itfti� (x) 1 $ 69.00 Sb/ '+ 1 (�S n 1y ttfiedT�retrg}'panel,ature of signing ervisor ty`Ni 1 O $ 80.00 $en'on 2
WI to Each additional inspection:(1) $80.00 $
taw requires 1
ATTE iu^s adopted by the Ote9°Setfotth APPLICANT USE
tUles ate 001- (A) Enter subtotal of abo 130 I
{011ow ter. 'Chose h OP" 5ules by (Minimum Permit tee$804: $
1n00ARYo�mav0010thiouq e .-,
obtain o0piethe teleW. Gn (B)Enter 12% (.12 x[A]) g 1V
p090. ��e 0entet• (NOtUetility l notification (C)Technology Fee(5%of[Al) / $ t(
•wo-258.1-num fGe Yeei_�v- 332-2344)• TOTAL lees and surcharges(A through C): $ 9 7 6 C ■
SPRINGFIELD - CITY OF SPRINGFIELD
V ! 225 Fifth St
^OREGON TRANSACTION RECEIPT Sp5nghelSOR97477
I, 541-726-3753
811-SPR2014-00387
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www.springfield-or.gov 1875 MOHAWK BLVD permitcenter @spdngfield-or.gov
RECEIPT NO: 2014000376 RECORD NO:811-SPR2014-00387 DATE:02/21/2014
jDESCRIPTION ;_ _ 7 n— ACCOUNT CODEITRANS5ODEa '' AMOUNT;DUE. j
Balance of Minimum Electrical Permit Fees 224-00000-426102 1004 11.00
Sign or outline lighting 224-00000-426102 1037 69.00
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
LPAYMENT TYPE'''. .7'PAYOR CASHIER:DBOWLSBY COMMENTS " ' .'.+' AMOUNTPAID 'n..„
Credit Card linda padilla 93.60
021592 .
TOTAL PAID: 93.60
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