HomeMy WebLinkAboutPermit Electrical 2009-1-6
Electrical Permit Application
225 Fifth Street.Spririgfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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'KW'Yi,DERARTMENT.,USEiON~Y: "
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I Date: \- \9~~ I
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for ]80 days.
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I Zoning approval verified? 0 Yes 0 No I
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I Job site address. \"12-0 JY\I\P-~ ,\,r I
I City: <pr<.il1lC,f11'?L.P I State: 0(( I ZIP;Q1477
I Subdivision: I Lot no,: _
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I Name: MtCIIA-t;;L 1fJ, .f.orC"i>JS,(l R- '-1
I Address: (070 '1'YI~I(tcr <;';--:- I
I City: (1lIl.//J(_f=IF( ~ I State; O~ I ZIP:q 7'f77
I Phone:' ('It ":1111-1 JOt 1 I Fax; ,
I E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family, This
property is not intended for sale, exchange, lease, or rent. OAR
4:9.540(1) and 479,560(1), /7 ,
SIgnature: .. ,!4J",16Af1I// (t(t/MAj",__. ..'
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I Business namerJ-OTI~E:
Address: TH'~ r::r:
~ Ifoll E::r;F;~ If. ~Hj; WORK
, _ :l!!~ pE'RKm' I€ N9l-
gJ""e
City:
I Phone:
, I E-mail: ANY 180 DAY PERIOD.
I CCB license no,; I BCD license no,:
I Signing supervisor's license no.:
I Print name q{1'W!im~~~!ln law reCJ.ulr~~'y?~}\?'.
I ' " ,wle.<;,adQpteo oy 1I "" v' ~"V.. 'J ......
Signature ~frs'~m..~~)\fYJ.~\I." Thnse rules are set forth
Iw,,,.v~..vr, ~-" h h OAR 9o~-UU I.
in OAR 952-001-0010 t roug
0090, You may obtain copies of the rules by
callin the center, (Note: the tele~hone
'bg for the Oregon Utility Notification
num er M 2344)
Center is 1-800-3.>;<- . '
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440-2584-) (9/08/COM)
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I Residential, per unit, service included:
11,000 sq, ft, or less (4)
I Each additional 500 sq. ft. or portion
th~reof
I Limited energy (2)
I Each manufactured home or modular
dwelling service or feeder (2)
I Services or feeders: installation, alteration, relocation '1
t 200 amps or less (2) \ I $ 81,00 $ ~ I P'1
I 20 I to 400 amps (2) I $ 95,00 $
I 40 I to 600 amps (2) $158,00 ,$
I 601 10 1,000 amps (2) $205,00 $
lOver 1,000 amps or volts (2) $469,00 $
I Reconnect only (2) $ 63,00 $
1 Temporary services or feeders: installation, alteration, relocation . 1
I 200 amps or less (2) I $ 63.00 $ "I
I 201 to 400 amps (2) $ 87,00 $ .1
I 401 to 600 amps (2) I $126,00 $1
lOver 600 amps or 1,000 volts, see services or feeders section above~:1
I Branch circuits: new, alteration, extension per panel ,. J
I a. Fee for branch circuits with purchase ofa servic.e or feeder fee: !!I
I Each branch circuit I L\ I $ 6,00 I $?A~I
1 b. Fee for branch circuits without purchase of a service or feeder fee: I
'1 First branch circuit (2) , I $ 55,00 $1
1 ..1 Each additional branch circuit 1 $ 6.00 $
1 I Miscell~neous fees: service or feeder not included
1 I Each pump or irrigation circle (2) $ 63;00
I I Each sign or outline lighting (2) $ 63,00
I I Sigmllcircuit or a limited-energy panel, $ 63.00 $
. alteration, or extension (2)
1 Each additional inspection: (1)
$134,00
$
$ 25,00
$
$ 32,00
$
$ 63,00
$
$
$
I
I
I
$58,00
$
(A) Enter subtotal of above fees
(Minimum P~rmit Fcc $58.00)
I (B) Enter 12% surcharge (,12 x [AD
I (C) Technology Fee (5% of[AD
I TOTAL fees and surcharges (A through C):
$ \{)\~ '
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$~ 113.'l?
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SPRINGFIELD
December 8, 2008
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
www.ci.springfield.or..us
Michael and Sheena Roseberry
1920 Market Street
Springfield, Oregon 97477
On December 5, 2008 our office issued permits to you or your representative for an
addition t<,J your residence located at 1920 Market Street, Springfield, Oregon. While
calculating the fees for that permit, the plan reviewer neglected to include the Fire
Department Fee, leaving a balance due of $21.18 for this project.
Please pay the amount due prior to requesting your [mal inspections for this project. I
have enclosed a prestamped envelope for your convenience.if you wish to make payment
by mail, or you are welcome to make payment in person at our office. Our office hours
are 8:00 a,m, - noon and from I :00 p.m. - 3:00 p,m. Monday through Friday. I sincerely
apologize for any inconvenience this may cause you.
If you have any questions please feel free to contact me at 541-726-3790.
Si,ncerelY, ()\,
\Jti\) \
Lisa Hopper
Community Services
Building Safety
,
l,
225 Fifth Street
Springfreld, Oregon 97477
54'1.-726-3759 Phone
Job/Journal Number
COM2008-0l693
COM2008-0 1693
COM2008-0 1693
COM2008-0l693
COM2008-0 1693
COM2008-0 1693
COM2008-0 1693
Payments:
Type of Payment
CreditCard
cReceiotl
RECEIPT #:
2200900000000000016
. Description
Fire SF Fee - Residential
+ 10% Administrative Fee
Perin Serv/Fdr 200 amps or less
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
City of Springfield Official Receipt
,
Development Services Department,
Public Works Department
Date: 01106/2009
Item Total:
Paid By
MICHAEL ROSENBERRY
Check Number Authorization
Received By Batch Number Number How Received
lIh 133186 In Person
Payment Total:
Page 1 of I
]:46:5]PM,
Amount Due
19.25'
1,93'
73.00,
81.00,
24,00,
8,90,
21.36,
$229.44
Amount Paid'
$229.44
$229.44,
1/6/2009