HomeMy WebLinkAboutPermit Electrical 2009-10-9 (2)
225 Fifth Street. Springfield, ;OR97477. PH(541 )726-3753. FAX(541 )726-3689
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~:'\;~DEI?ARTMEN1;USE ONL:Y
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Permit no,: QC\.. \41:)
I Date: ': \0. C\ . ()q
1, "
Electrical Permit Application
8
This perl)lit is issued ~~der O.AR 918-309-0000, Permits are nontransferable, Permits expire if work is not started within 180
days of i~~uance or if 1"0rk is suspended for 180 days,
1'''''''''''.''''''''''''0. CA. e'.G O.ERN . T'" "0. V.A ."'",,"111!i'_"1 I""."'"'' '."""""'.''''''''F .,S ' ,................ .1
~,i'i;:,:~~1\j';,~.&~t,'f1!,$..a.;. " ,'::';;\'..- Y . MEN;,\'\,AF!r;;R' ^ , ' l~~~i~.'J':r;t',,\,11':0-;.;1%;,\,1'4j rt\'l-- c.'\\,;\\;';''; ,.,>
I Zoning approval verifi~d? . D Ves D No .' 1 l;lii~~.~~~1~fi~1~~~i~i:Ji~ifl''';:~~'~:'I>~~~fl
IRlt~f;~~':I\'~~~i:CATEGORYXOFi~CONSTROCTION'~}~f~:;r~j::':..;i';;1
1 .1" Residential, per unit. service incl.uded: I
I 0 Residenlial ,I : D Government I 0 Commercial 1
il'1'1",fi,)fIJOB1;SITE~INFiORMATION':'ANDi:l.:OCATION' ,{i~i:2~',1 11..000 sq It or less (4) $134,00 $
1 Job sile ~ddress; 2..::>~:J. \\m~' _ \.G .... 1 I ~~~~Oal?dit~00aI500 sq, ll, or porti?n $ 25,00 $ 1
I City: ~(\ . te:..... \ ZIP:q~-nl 1 Limited energy (2) \ $ 32.00 1l:lL...
I Subdivisi~n: , " Lot no.: . ! I Each manufactured home or modular $ 63.00 -$
1~~~~~jpj;~:~i~T~,;1.~~~~~D~s.cRIRrION;.OF\j~\~On~~!~:~ff:~~T\!i!:~D:il dwelling service or feeder (2) I
I ~)( Q r* ~)\~ \\Jl. ~ I 1 Services.or feeders: installation. alteration, relocation I
1 d,.. \ l1\ ~\\- ~,' I 1 200 amps or less (2) \ $ 81.00 $3 \ 1
i~"e~tti'~i ::::::::L ::: i
1 City:V Iy\ff\Q-- ..' fstate: ~ 1 ZIP: Q14tfLJ.. lOver 1,000 amps or volts (2) $469,00 $
I Phone7' . : \ .. 1 Fax: I 1 Reconnect only (2) $ 63,00 $
I E-mail: 1 I Temporary services of'feeders: i~sta"ation, alteration, relocation I
This installation is beiJlg made on residential or fanTl property I 200 amps or less (2) $ 63.00 $ 1
owned by me or a member afmy immediate family. This I 20'1 to 400 8111PS (2) . . $ 87.00 $ I
property js not intendea for sale, exchange, lease, or rent. OAR . 1 I
479,540(1) and 479,560(1), . 401 to 600 amps (2) $126,00 $
Signature'; lOver 600 amps or 1.000 volts, scc serv)ces or feeders section above 1
1~~~!:l\"~'fai;-c:.o.NTAACJOR~'INS;r~L.LATION~gf~t~~l~~~~1l~~t~ ISranch circuits: new, alteration, extension per panel 1
I Business name: 1\...a..11l, f1)n,lf. ,,(' lt~ ..# ;. .J 1 a, Fcc lor bra~eh circuits with purchase of a service or, feeder fee: 1
1 Address::' (JD V'w ~ "..:v f;,'l)3 . I Each branch circuit 1 $ 6,00 I $ 1
1 City: 111 q; /Yt~ ;, . I State:!'J1'. 1 zlP97i./ /) :;21 b, Feefor branch circuits without purchase ofa service or leeder fee: 1
1 Phone;:5l./LARt,:~L51 Fax::)'L/M~-;:;'715 First bmneh circuit (2) I I $ 55,001 $ 1
1 E'moJl:U./J1J/J(h)~hjf:tN;L.~ Each additional branch circuit 110 $ 6,00 ~\n
I CCB lice'nse no.: 5~CDlicense notZJ~1 C/SC I' Miscellaneous fees: service or fee..der not included - 1
I Signing supervisor's liCense no.: r..C{ :itS;;; ..s I Each.pump or irrigation circle (2), $ 63.00 I $ 1
Print name of signing superviso Each sign or outIi~c Iighling (2) :: $ 63.00 I $ I
Signatureofsigning'su:'~visor: ~ Signal circuit ora Iimitcd-energy paneL I $ 63.00 $ . I
.. alteration, or extension (2)
,-
'" ~ ~ cP' 1~:;,~~~~~;;I:~';~~Ac~:;/ICI)A'" NT':UI SE'\'"'~";~'~~~"'t",$'"\;;''''''';11
. ~~~. "",~....'1,"'",iS,~~$Ii,*,.~i"~g,"-:l'f.... r:;r;;LO ",E, ,v.~j!ij-,,~cf~~Jti!,''iit-;;;,\l.W,''''''!J'~'"''h
ATTENTION: Oregon law requlres,you to SJ:-\, /OQ-' I (A) Enler subtotal of above lees II r'If"l'
follow rules adopted by the Oregon Utility \l~'ZP (M;n;m um Perm;t Fee $58,00) . $ loU"
Notification Center. Those rules are set forth I' . ,
In OAR 952.Q01.()()10through OAR 952.Q01. (8) Enter 12% surcharge (,12 x [Aj) $ 'L..ro.
0090. You may obtain' copies of the. rules by NOTICE' 1 (C) Technology Fee (5%oflA]) $ \nA 0
call1ngthecenter. (Note: the telephone, . TOTAL fees a l~roughC): I di14'2\:c::-.Q.
number for the Oregon Utility Notification TH IS PERMIT- . . v <:>
Center Is 1~.2344). AUTHORIZED UNDER THIS PERMIT IS NOT
440,2584,) (9/08/COM) ':'\..(~'. COMMENCED OR IS ABANDONED FOR
. ' ~~\-\o~.;...,;\\ ANY 180 DAY pERIOD.
.....l'
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10/09/2009 13:40
541-585-2715
PAGE. 01/01
Electrical Permit '.Ai
2Ui film, .~frttl.Sprin~fi.:ld, 01l.97477_ PH(54l)7Ui..37SJ. FAX(541)126~3(j89
...[)~eARtIv1ENT Use ONLY
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Permit.no.:
Dale:
Thi. pel'lDit is issued under OAR 918-309"0000. Permill1.re nontron.fernble, Permilll expi..e If work i. not .l:>rled within 180
days ofjssunnce or if work is ::>I,spended for 180 days. .
I LOCA:li'!GO.VERNMEN1\'JliI'1I!ROVAI:;'" :"( k'" ....... <FEE,:SCHEDUL.E . 1
: 19ning app~~~ Vetifit OF G ~~;RUCTIO~ ~o ..... 1&~~~e':~tlti;~~<li~:~P~t;lt...i) IQiy,1 19~ ~~~~l J
I ~;CSid:~;;"J .EGO~:Gov~rn~enl" .. .. '. Co,~':erci~1111Ie'id'~lial,per u"it,'e~;r~i"cl"ded: . . j
IJObS;;~~~;::~~~;;~~~~:~~/~~fjll i;~~:'1:i~~::i:~0(:~,ft'Orponion :1:::: I: I
I City: S~I).(),~~t.: ol J lIP: _ I Umiled 'nergy (2) ,. I $ 32,00 . $ 3z.t:IO
iS~~di~iSion:;5i:e~'F:'TION;:'Q~.wJ~~lno.: ,..,~I ~~~~,1~:"~~~i~r~~~~ld~r(i)Od,,'~r I $ &3,00 .$
. ~ \ '. fi... .D.. .4dJ. .... ..... tQ.. 1'1.. ~I.lli. .. tlNh~. \ ~. uJ1,... .. ~ I Se~lee. or reedO"'.: in,"alla/;an, alleraffnn, relocallnn I
~~.?~\~~:~~p.~!lf~~J~~~,mrrit:?~~:~::o~o:~::((:; ..! I I ; :~::: ;tCOjD
I Name: . . i I 40 I to 600 amp' (2) I I $15B,OO.$ I
I Address: I 601 to 1,000 amp' (2) I $~06.00 I $ I
I City: I Stale: I ZIP: i lOver 1,000 amp' or vole. (2) I $469,00 I. $ I
I Phone: , Fax:,- I I Recon"<., only (2) I I $ 63,00 I $ I
I E.mail: IIT<mporn>y.....lee.orr..de..:/l1.<lallalit....allerallan.relncalinl1 I
TI" II' -, b-' -'d 'd I'., ' 1200"mp'Orl"'(2)~$ 6300 II
liS Insta atJOn IS elng.TtlEl eon resl en fa or farlll property 'J I, 1.$ E . .
owned b~ '!1.c or a member of my irnmedinle family, Thi, I 201 to 400 amp' (2) I .$ 8700 , $
property IS not intended for swe. c"X:change. lease. or.rent. OAR I ' _
479.540(1) and 479,560(l), . .. 401 to 600 ''"p' (2) I I $126,00 I $
SignAture;, J Over 600 amps or l~OOO \lolts.. see sl;:ryicc!:l or/ceders section o.bove
I. '.' "&~:.""''''''Q/V..'' 1 .~."'_", _ .",.,'" ...'" ~,_,
I B.U'ineSS"'mo:_ WJ.. lili,..l...1S=:'\f!.li'V, ( _ J 'o,Feeforh"nehe;rcuil,wilhpuO'Ch.,cor.",rviccorfeederfee: I
I Address:PO j'lSCf.~ J I Eaeh bmnchc;ruuit l/Jp I $ 8,00 I $&f("f)f-J
I City: k.~. I Stnt~~ I ll~?(j'O ~ I b,Feef(;rb...nchrirel1itswlthoutpllrcha,cofnservlreortcederfce: !
I Phone: ,_~~..5.J r~' ~t~~ - ;;i....::}Q.1 PI", brooch cl"'";1(2) I I, $.55.'00'1 $ I
I E-mail:. Barh >ldditio",1 broneh ej"''';t I I $ 6.00 I $ I
I CCB lieenge.no,: 5./D 't-<( I BCD license no,: 2o,,&c. I Mlocelloneo"." ree" ~al'v;~" ol'feede/' nat ;nc/udcd ,-J
Sigr:!ing_Slmervisor's license no.: ~:::?~.5 1 I E..lch pump or Irrlg1.l,hon CIrcle (2) $ 63.00 ,$ I
Printoameofsign~ngsUPervisor: crust ~~G(;.j I J B()chsig2IOTOllllinclightihg(~) ! $ 63.00 $ .
SiO"naturft:Or~.'i{'l'n'ng l ....... .'rl' \ I I SigMI_CircllitOl'n.li~.'itecJ-c:nergypnncljl $ 63,00 $ I
_eo _ _~:_t; '_ S ~~'e, ~I~~.. _ alteratlon. orCXt'CI1SI0n (2). ,
... \ , Illoeh .~dilioool in,peclion: (I) I. ' I $58,00 I .$ I
" -Q\ D_ LD 1'\" 1.e. \ L D'o" \ \ ()\ \ \' '.,' ..,.'" !,.;,.';; ,., :.':":;h'\~'''''/:'I'''''&'~''''>''''''''''.'''<.::.' "..,.. "." .,.,..., '..,. ..,
'" r \v.<"',- vI ,l',-, ... ~"'.""'. !,." L"../~:4''''1r,;.. "'''''!I:'",'''~c",.;.,.::,!:",':',!.!''i',.:.....':".:.,.
u.- ' 1 ~ r7 d ! fA) Enter subtotal (If above fel:6 I
':lX \ "? ZOb1 - iO'j I D I (Ml;,lmlOm PermilFoe $SR,OO) $ 6bq ,C 0
!<B)EntcrI2%,urehnrge(,I<x[Aj) : $ 016,<:)><:6
I (C) Teehnology Pee (5% of[AD $ I () ,I./.f)
I TOTAl. roo, and '"rd..rge" (A Ihr~II~" C): $;;~ij,ff;J3
440.25'4.} (910H/COM)
II Receipt No: 2200900000000001166 II
iiiiiiiiiI
Line Items:
Job/Journal Nii.D1~ Tran Cod
, COM2009-01387 ,1004
COM2009-01387 1004
COM2009-0 1387 1004
COM2009-01387 2099
COM2009-0 1387 1099
Payments:
Method
CreditCard
Paid By
NEW WAY ELECTRIC
Transaction Log
, For Date: 10/09/2009
Oescrilltion
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 12% State Surcharge
Rcceivcd
Check
1>"
"'~
DJB
Page 8 of 12
10/16/2009
1:17:29PM
City of Springfield
Development Services Department
Public Works Department
Revenue Account No
Amount Paid
$81.00
$72.00
$32,00
$9.25
$22,20
$216.45
224-00000-426102
224-00000-426102
224-00000-426102
100-00000-425605
821-00000-215004
Line Item Total:
How
Amount Paid
Annroval #
Dn..,..1
619063
In Person
$216.45
$216.45
Payment Total:
cTransactionLog.rpt