HomeMy WebLinkAboutPermit Electrical 2009-7-31
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'Electrical Permit Application
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225 Fift~ Streett Springfield, OR 97477tPH(541)726.3753tFAX(541)726~3689
Il:"~f:9E~~RT~ENi,'USE\C>~tr;'f~:I!'
I pennitnoc:.q - ~C\ \ I
I Date. . /'?!- D1 I
This permit is issued under OAR918-309-0000. Permits are nontransferahle. Permits expire if w~rk is not started within 180
days of issuance or if work is suspended for 180 days.
1,4;\"f''''l''''''OC'A'''"GOVERN MEN' To"AnnRO VA""'" '}(""'''''''''j 1":1:'!i'1i::':':';"",~",",,..";;c1iZ4"EE"_'SCHEDU' "E:',
-i-. .~-;-''-i--'l.:;;'".;i;:'::"",c:.. . L;;f. .. ' 'A , r:r.;: '.' L-'{":<;A. -....~"..~."'-''4'''. '.,_."c-"'_.< ..., ""__ ..r.._.." ".".. ,;,".~r; _ . . L;; ,~"."
I lonin. g approval verified? D'Yes, D No If;~'i(Ii~~?~~'~~~~~1ti2~~1;~flit~~_~)~;':IQ~I:~~~~~~~~::'~lt~t1i~~I,~~1
1:~t;:~~:i~IATEGIR~~~~:::~TRUI~O~~~~~~:~t;:':i 11'~:s7~e:~:~'pe;un;t,::r~i::i:CI;::;; ,., ""',' AI
IE\crEC:'JOB'~SITEmINF.ORMA1JONF'AND~lliOCATIONN!,fu:;1!S~1 1.000 sq. .or less (4).. $134.00. $ I
I . . . S......a I " 'I I Each additional 500 sq. ft. nr portion $ 25.00 $ I
Job sIte addres.. I 10 mAl" .5f<.Wrthereof
1 City.5'#",.~ U I State.c<" . I ZIP. If")<{ 7'0 I I Limited energy (2) $ 32.00 S I
ilo~~~:::~~*~;'~'~~~S~~~:~OFi'wJ~~:;;~Q~)~i I ~~~~I~~nS~~~~~~~e:~r(;rodut $ 63.00 > I
I ~ AI ....-:- 1 J J I -I Services or feeders: installation, alteration, relocation '1
t"iJ'\,.l.,.. A/~ \ I'lo&n--u,,~ .
I I 200 amps or iess (2) $ 81.00 S
I ',,,,,O?#;J'I;;;pw""i''''''''''''RO''ER''"''''O W NER,":nc,""":'.\;;"," !'i>iiL1','''c I 201 to 400 amps (2) $ 95.00 $
. ../o.""-^'1 ~..'" ';':";;';' ". "'.[':".. ,.. -;o~. - . ,~~ r:;: r; . I ~,.I ;'o( . 1*,'~,~":",,i"- -"-"",""\-"''!:<;;'~'' .,.~~,;\l"I'j,.%'#,.":;
I Name.~ ~~ 1401 to 600 amps (2) $158.00 $
I AddressA,.ICf '"1 (V\J.J..'~ p~ I 601 to 1,000 amps (2) $205.00 $
I City~'1Ml ' I Sta~ rt)..1 ZIP: Cfl417 lOver 1,000 amps or volts (2) >469.00 $
I I I Reconnect only (2) $ 63,00 $
Phone. - Fax. - -
I E-mail: I Temporary services or feeders: j'fstti/lation, alteration. relocation
I 200 amps or less (2) I $ 6300 $
This'installation is being made on residential or farm property .
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $
property is no~ intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1). 401 to 600 amps (2) >126.00 $
Signature: Over 600 amps or 1,~OO volts, see s~ces or feeders section above 'I
1~~~D~::~tk~~JlcON1!RACrbR~INS;rAl!iiAtION!~~~~'~~r~~Nl~~;t:~~ @;~~ I Branch circuits: new, alteration, ~ten~ion per panel I.
I Businessname:~~ ~ - \o..",{>:A&..lse) I I a. Fe'e for,branch circuits with purchase ofa service orfeecter fee: I
I Addres.. l"Ioto ~ ~19'Il'. I I Each branch circuit I $ 6.00 I $ I
I City: ,~OLu'\,.r(t1Jl ' I, StateOA...:. 'I lIP: 'i7Cf17 I 1< b. Fee for branch circuits without p)lrchase ofa service or feede: fee: 1
I Phone5'1~ ~3.~3. -S"'S"I.'5"' I Fax:~<tI-~'ZEl'-t '37S11 I Firsthranchcircuit(2) I $ 55061$ I
.1 E-mail: t D (,..I.oof ~ t.c.~~. n.c.J- I I Each additional branch circuit $ 6.00 $ I
I eCB Iicen~ no.~ ".,( tj~ r BCp license no.: $-'SS1LLJ:' I I Miscel~aneous fees: service orfeeder ;lOt,inclilded I
I Signing supervisor's license no.: 1..Ji)~U LV.A. . I I Each pu'mp or irrigation circle (2) $ 63.00 $ I
. I Print name of signing supervisot:(" Q--1"\ ~ I I Each sign or outline lightin&, (2) $ 63.00 $
I. .... '.-1" [L.., ii' Signal circuit or a limited-energy panel, I $ 63.00 J_)'
SIgnature of slgnmg supervIsor.. 10-, _ ). . alteration, or extension (2) $l;
. w~ I Each additional inspection: (I) $58.00 > I
ATTENTION: Oregon law requires you to ._ ~ l~f~'IL~~_$AR~l!ICAN;rwiusS!~'llf~~,r;:!!~1
follow rules adopted by the Oregon Utility ~ ~ I (A) E b I f bel
. . nter su tota 0 a ove lees ?
Nollflcatlon Center. Those rules are set forth .. \:" "$ {j /
in OAR 952-001-0010 through OAR 952.001- ,-: N (Minimum Permit Fee $58.00)
0090..Youmayobtain'copi&~Oft'. rUleS~T1CE~ I (B)EnterI2%surcharge(12x(A]) $ 1.5& I
calling the center. (Note: If, ,ephon IS' I C)TeclinologyFee(5%0f[A]) $ 7"/~ I
number for the oreg~n ,. Ii Notlficatlo PERMIT SHA~ ""0:1:-;:";: - H \ I
Cente~is -8 '. " 2 r-il. AUTHORIZED UND~ ~Or~i'~~~~La,J.d1'iir~\\a~Ms (A ,through C): >7i 7/ I
~ ~ I /,Iv cLn,v,ll '01VUI
C-! COMMENCED DR IS ABANDONED FOR
440-2584-) (9/08/COM)' ANY 180 DAY PERIOD,
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225 Fifth Street
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SFingfield, Oregon 97477
541-726-3759 Phone
City of Spr~ngfield Official Receipt
Development Services Department
Publie Works Department
Job/Journal Number
COM2009-00597
COM2009-00597
COM2009-00597
Payments:
Type of Payment
CreditCard
cReceiot!
RECEIPT #:
1200900000000000856
Date: 07/31/2009
Description
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
STEVEN SCHMUNK
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
lIh
005848 In Person
)
Payment Total:
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Page 1 of I
12:09:52PM
Amount Due
63.00
3.15
7.56
$73.71
Amount Paid
$73.71
$73.71
7/31/2009