HomeMy WebLinkAboutPermit Electrical 2009-3-23
Electrical Permit 'Application
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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I Pe~it no.C;,K .. \~S I'
I Date: ~'2.3 '(J1 I
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.
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I Residential, per unit, service included: -
11,000 sq. ft. or less (4) I $134.00 $ I
I Each additional 500 sq. ft. or portion I
thereof $ 26.00 $
I Limited energy (2) , I $ 32.00 $ I
1- Each manufactured home or modular II $/ 'J. .::v I
dwelling service or feeder (2) $ 63.00 (p ~
I Services or feeders: installation, alteration, relocation
I 200 amps or less (2) $ 81.00 $
I 201 to 400 amps (2) $ 95.00 $
I Name. 40] to 600 amps (2) $158.00 $
. I Address: 601 to 1,000 amps (2) $205.00 $
I City. State. I ZIP. lOver 1,000 amps or volts (2) $469.00 $
I Phone: I Pale I Reconnect only (2) $ 63.00 $
I E-mail: Temporary services or feeders: installation, alteration, relocation
h.. II' . b . d 'd' I C 200 amps or less (2) $ 63.00 $
T IS msta atlOn IS emg ma e on reSI entia or ,arm property
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).' I 401 to 600 amps (2) $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
i!\JIh~cbllli1i~Gj1ibR11IIISmJl:I1!I!AmION~~"!1l4!'ii1f(1~~ I Branch circuits: new, alteration, extension per panel
Business name: lJ.A1;1 tJ _<Tude 6--t.LrCTJelc I I-t--c.. I I a. Fee for branch circuits with purchase of a service or feeder fee:
I Address. fJ.c.._ fllcXJ Z~&z- NOTlr;F' I I Each branch circuit I I $ 6.00 I $
I City. Ea @k=.- I State. J)<J1S AEmvtl b. Fee for branch circuits without purchase ofa service or feeder fee.
I Phone:Y-l{I-Y9'.3' C/{'/fj I Fax~r~/2flnJNDER ~_r~jltl~~(2) I I $ 55.00 I $
I E-mail: I"VIVI/VltNCED OR IS A A .1., \kn~f-l,fanch circuit , $ 6.00 $
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1 CCB license no.: ()ff') 77 I BCD'litens'e nUoY~!.fj~~.' Miscellaneo~sfees:'service or feeder not included
I Signing supervisor's license no.:' .4<"'72 S' I Each pump or irrigation circle (2) $ 63,00 I $
I Print name of signing su;'er~i~~~: !JA1/I',j;1. SlU-k' I. Each sign or outline lighting (2) $ 63.00 $
I Signature of signing supe';'isor: fl. P? eP ~~. I I Signal ~ircuit or a limited-energy panel, $ 63.00 $
~~ /-< ~a?, alteration, or extension (2)
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~Residential I 0 Government I 0 Commercial
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Job site address: Z I'-is- .:t/~ ...:oh3!' p '1 'Z.
I City. SIJ{,I:.f4e!d IState:c.~ I ZIP:Q7.tr71
I Subdivisiou. (,)e..IccM" tpo-<rr I Lot no.. q Z
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ATTENTION: Oregon law requires you to
lollow niles adopled by the Oregon Utility
Notification Center. Those rules are set forlh
In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the teleph Je
number for the Oregon Ulility Nolif . ~ n ..41
Center is 1-800-332-2344). blJ\
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'VJ\p
440-2584-) (9/08/COM)
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I Each additional inspection: (1) $58.00 I $ I
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I (A) Ent~r subt~tal of above fees - I
(Minimnm Permit Fee $58.00) $ {;; <!N
ÖI (B) Enter 12% surcharge (.12 x [A]) $
I (C) Technology Fee (5% of[A]) $
I TOTAL fees and surcharges (A throngh C): rt -g.:~C{
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Publie Works Department
Job/Journal Number
COM2008-0 1815
COM2008-0 1815
COM2008-0 1815
COM2008-0 1815
Payments:
Type of Pa~mellt
CreditCard
cReceintl
RECEIPT #:
1200900000000000206
Date: 03/23/2009
Description
Manufactured Home Service
+ 5% Technology Fee
+ 12% State Surcharge
***+ 10% Administrative Fee***
Paid By
DAVID STUCK ELECTRIC
Item Total:
Check Number Authorization,
Received By Batch Number Number How Received
5569b
5569b In Person
Payment Total:
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Page 1 of 1
II :57:4IAM
Amount Due
57.00
2.85
6.84
5.70
$72.39
Amount Paid
$72.39
$72.39
3/23/2009