HomeMy WebLinkAboutPermit Electrical 2009-9-1
Electrical Permit Application
225 Fifth Street. Springfield, OR 97477t PH(54 1)726-3753t FAX(541)726-3689
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Permit no.: ~ '1 ..... 53 (
Date: () 9--- 01 /09 .
This permit is issued under OAR 9IS-309,-0000. Permits are nontransferable. Permits expire if work is not started within ISO
days of issuance or if work is suspended for ISO days.
I ;,"" ".":.lEoC"'L:GO\,lE_RI'iMENT\i1f.F1!>,ROVAllif;t~l';fii"mtl
I Zoning approval verified" D Ves D No I
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I ~,Residential I 0 Government I 0 Commercial I
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I Job site address: I <O()" 5'11- 5""'-
I City '5Jl(!,f.1whM I State: DR I ZIP: q rat- I
I Reference: I Taxlot.:
'f ;.;.':"'DESCRIPi:ION:,;OF-,WORK~,~~'ii;f~;i;j~i~J~;::'~';:
I nu"n.M!'> I l.Il:'\-VI( I (\~iUl,OAiU) ~ I
I IN fJi1!.l1kL r;,~ UJ1vv{tJLC,tJ9iJ
!:,;PROP,ERTY:,OV'VIIIER .:.:.;.
I Name \\tt L..\ ~ f.k;,..-t...v',vO
I Address: UW\ 0" 5T
I City: Sf/Z-,tJb j:.d,M) I State: OiL I ZIP: O,7lf77
I Phone: S'i \ - 7W \'\ \ ~ I Fax:
I E-mail: Wl.1 e..J 1o.c,.0@ f6\ IV W . w'^-'-
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
1,:~~n~~~~I:~~INSTA~~MION' .,
I Business name:
I Add!ess: ...................-
I City: -----..-~ I State: . A ZIP:
I Phone: '~JFa;z:
I E-mail: /// ~
I CCB license no.: // ,I BCD lic~",o.:
I Signing suge.-vr;or's license no.; '"
I Print nafue of signing supervisor:
l Signature of sig~ing supervisor:
.-
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NOTICE: ' C\.f}; S<J.,,(
THIS PERMIT SHALL EXPIRE IF T~~
AU rHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY i 80 DAY PERIOD. '
440-2584.) (9/08/COM)
t2~>i~MiF:l1~~f(.~~~e;'F,;EE;~5'"CHE_O.Cf~_I;_?f'J$f~l~liJ,~~fr~~
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I Residential,per unit, service incJud~d:
11,000 sq. ft. or less (4)
I Each additional 500 sq. ft. or portion ,:)
thereof
I Limited energy (2)
I Each manufactured home or modular
dwelling service or feeder (2) . <
r Servic'es or feeders: installation, aite~ation, relocation
I 200 amps or less (2)' $ 81.00 $
I 201 to 400 amps (2) $ 95.00 $
1401 to 600 amps (2) $158.00 $
I 601 to 1,000 amps (2) $205.00 $
lOver 1,000 amps or volts (2) $469.00 $
I Reconnect only (2) $ 63.00 $
I Temporary services-or feeders: inst~llation. alteration, relocation
I 200 amps or less (2) $ 63.00 $
I 201 to 400 amps (2) $ 87.00 $
I 40 I to 600 amps (2) . $126;00 $
! Over 600 amps or 1,000 volts, see se~vices or feeders section above
I Branch circuits: new, alteration, ext~'nsion per pane!
I a. Fee for branch cir~uits with purchase of a service or feeder fee:
I I Each branch circuit I $ 6.00 I $
I b. Fee for branch circuits without purchase of a service or feeder fee:
I First branch circuit (2) I $ 55.00 $
I Each additional branch circuit ..$ $ 6.00 $
I Miscellaneous fees: service or feeder not included'
I Each ,pump or irrigation circle (2) $ 63.00
I Each' sign or outline lighting (2) $ 63.00
$134.00
$
$ 25.00
$
$ 32.00
$
$ 63.00
$
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I
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I Signal. circuit or a li~ited-e:nergy pan,~l, $ 63.00 $ I
alteratIon, or extensIOn (2) '.
l,E;a~~I~q,d!~j~Hl"\.il1~P'~f~W~V ,(!.buires 'OU t) $58.00 $ I
f(I,'~I'0l1;'1:lZil\~~Jlli;y"'~r:MARgUTeANjj"U'S"E-1iJ:"*If;'ii!~,,:jl1\Vi;'ifr!.;;'i!~ii;'1
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N'I"('Ar)"E"~~ ("'b~th~1 rTCb"OP;1118S are seI IU! [II 7.J ' p
, ,.c nter su ota '0 'a ove lees 7 l
l'n O('M" C~9-nop< -nn.1t()Fth'$nS'S'''0'hO)OAR 952~001- $ - ~
Immum erml ee; h I h ....., f I
DC ~::;. '/:;,;.. ';;'.::::; :::.':'.:~ ':'rI.;-'IOC:: nf t" P rlJ p.~ V 5 ~ fL) ::->
(.:qR~l1ttr1I.2r't~~!!!\J.arge:('!i!:x[A:]) elephone $ g--, tY'
Ijl(G)lJ;echnologyF?e((~'8iJ>(rXjj'LI:.?:ii1CallOn $ I
I TOT1Lt::f~~~laWd ls-ur~ha';-g;s (A t,h~ough C): $ ;('5-# 1Y'1
$
$
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100 amp Sub-Pan.
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- Four Gang Outlets
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22'-11" /
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69.65"
..............
Light Fixtures -
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Light S~ ~es
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'~;~IVolt Baseboard
~ter
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Four Gang Outlets
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69.4T'
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23'-9"~
I[ Receipt No: 3200900000000000623 ~
Line Items:
Job/Journal Num~ Tran Cod
COM2007-00537
COM2007-00537
COM2007-00537
COM2007-00537
Payments:
Method
Check
1004
1004
2099
1099
Paid By
PHILIP EASTLUND
Transaction Log
For Date: 09/01/2009
nrsc:iD!;on
Add, Alter, Extend Circ Ea Add
Add, Alter, Extend Circ
+ 5% Technology Fee
+ 12% State Surcharge
Received
Cheek
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N~
NJM
1099
Page 20 of 21
9/2/2009
8:11:07AM
City of Springfield
Development Services Department
Public Works Department
Revenue Account No
Amount Paid
224-00000A26102
224-00000-426102
100-00000-425605
821-00000-215004
$18.00
$55.00
$3.65
$8.76
$85.41
Line Item Total:
A. ".Ilrova J #
How
~
In Person
$85.41
$85.41
Amount Paid
Payment Total:
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cTransactionLog.rpt