HomeMy WebLinkAboutPermit Electrical 2009-7-13
22;; Fif~h Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
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II Date: f1 ~\~~r9\ - I
Electrical Permit Application
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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.
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;Oning approval verified? 0 Yes 0 No . fQ~IIiQS{;.i!l:1
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~~~;~lm~~~~~~~;J{&1)l'~~G~;&:~i~1E11 I ~~~;::ti:I.:,el::.n(~;service included: $134_00 $ I
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l M f1 '~~1\ _ (~"\ ~ l'\ \!'\I' X\._. _ I Services or feederi: installation, alteration, relocation [
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I Phone: _ _ . 1 Fax: _ _ .. I 1 Reconnect only (2) I $ 63_00 I $ I
I E-mail: ! I Temporary services or feeders: installation, alteration, relocation ,j
This installation is being made on residential or farm property 1 200 amps or less (2) $ 63.00 $ I
owned by me or a member of my immediate family. This 1 201 to 400 amps (2) $ 87_00 $ 1
property is not intended for sale, exchange, lease, or rent. OAR
~' 479.540(1) and 479.560( . : (\ n 1 401 to 600 amps (2) $126_00 $
Signature: "'\ ~ lOver 600 amps or 1,000 volts, see services or feeders section above
]!II1i~G:0'Nm~C.mQ8.1\1NSJfr71i1!1!~1l1~JI{~f\\\.;7E11'J'1 1 Branch circuits: new, alteration, extension per panel I
I B~ess^name: . II ~L 1 _ a. Fee for branch circuits with purchliSe of a service or feeder fee: .1
I Addre~ /iH/~';:;..J Eachbianchcircuit . 141 $ 6.00 11L4.CfJ
II City: ~ ,,-.1 Stlat~: / /1 Zl~~~~ ~~~~HH'~ l~~~~:tl.;;;Uits without purChasl e ofal service or "Ieeder fee: I
Phone: '-. fAX: - - ASANofi",,:,g (j mlr'''''''''flJJifll'''' (2). $ 55.00 $ I
I E-mail: / --...--....... <.- ,0 ~@6I Jsanch circuit' $ 6-.00 $ I
I CCB license no.: /". I BCD license ~()::---..,_ I [Miscellaneoui; k"li!ilQQce or feeder not included I
1 Signing sup~rn;;:;s license no.: .~"-.. I Each pump or irrigation circle (2) $ 63.00 $ I
I PrinJ.mUi;' of signing supervisor:. ............1 Each sign or outline lighting (2) $ 63.00 $ 1
I ii"gnature . - - . KUOJm'isor: I Signal circuit or a limited-energy panel, $ 63.00 $ I
. I... f~r10~efl { alteratIOn, or extenSIOn (2)
~U~~~e~CI%ted by the o;;;:t~~; r.?o':m~~~IoW Each additional inspection: (1) $58.00 1 $ I
001.0 l';roU::~~~~:2~~~~~ '~VAA 95~~Ol. ~~Fi[~rGP;:~1fI(fJ$g~~"'~1
~~~e,:,~. ~ ~~~~~ f~ ~~'~ the ~en,t~~ (~~re~~,:n (A) Enter subtotal ofabovefees $ fa }.jl.
Center Is 1.aoo:a32-2344). regon Utility NOlJfjcation (Minimum Permit Fee $58:00) :L- '-t~
I (B) Enter 12% surcharge (.12 x [A]) $ lJ-.'?fi.)
I (e) Technology Fee W/~ of [A]) $ \. tL
1 TOTAL fees and surcharges <A through q: $~
440'2584') (9/08/COM)-
225 Fifth Street
Spr.ingfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-00972
COM2009-00972
COM2009-00972
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000000795
Date: 07/13/2009
Description
Add, Alter, Extend Circ Ea Add
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
RONALD TOLLENAAR
Item Total:
. Check Number Authorization
Received By Batch Number Number How Received
IIh
By Mail
Payment Total:
.3597
Page I of I
7:39:43AM
Amount Due
24.00
1.20'
2.88
$28.U8
Amount Paid'
$28.08
$2H.UH
7/13/2009