HomeMy WebLinkAboutPermit Electrical 2009-11-9
Electrical Permit Application
~ . ~ ~
D l!l
225 Fifth Street+Springfield,OR 97477+PH(541)726-3753+FAX(541)726-3689
SPRINGFIELD
I.
~~~ ~.
~~
~~S~DE€~R1iM'ENlt!UWONlby.~I'
IH'h:';fi:;.,"R".:'iir.;':Ci>!C<l!-'~"C;1t",":~;J2ftNms~li:!.~;:,C~~~;
I Permit no C'I- 16-73 I'
I Date: Ll ~1 -M 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.
~~~":.~~_IiE;E;iS:C:8IODJ'JLtE~~~
:li,'N','W!.i1"'b'~".""'r'1:'~t.~~i!ll1t"!\:"''''t'f1I5i!'':,:(~,':)'Z.~'''''.'I;",.'~',""'it,:'ill "IIll-€''Osi~I!;~T, 'oHl~,'"
'~ ,urn er~.o ,mspeclOhs,p-er;1 emJ ;.;)f$i~~ Sl~J;~ , .. ; "-"i'Q:~ ~----'" '
&~~~~,!fCt}..i!tti'...r~~&tij.~~*k,1{0,f!Ji \0'4;~~ ilQ;rJhea~~'li' ri2o:&Q,st .
Residential, per unit, ser~ice included:
11,000 sq, ft. or iess (4) I $134,00 l1- '3W"-
I Each additional 500 sq, It, or portion I *
h r -r $ 25.00 ~r
t= l
I Limited energy (2) $ 32,00 $ I'
I Each manufactured, home or modular $ I
dwelling service or feeder (2) $ 63,00
I Services or feeders:. installation, alteration, relocation I
I 200 amps or less (2) ~ $ 81.00 ~?
1~~~:i~::~OW::~~~~~~~~~~f:< : :~: :::~~:::~~~ ' :1:::::: I
I Address: .w J 7-- ~PD;/ p;,ILJ;p~ ,e"p I I 601 to 1,000 amps (2) $205.00 $ I
I City: ~(A='cG1--D I State: ~ I ZIP: 0::;11?- lOver' 1,000 amps or volts (2) $469,00 $ I
I Phon<5ft- :J4-?--7-i5s I Fax: I Reconnect only (2) $ 63,00 $ I
I E-mail: I.Temporary services or feeders: installation, alteration, relocation I
This installation is being made on residential or farm properly I 200 amps or less (2) I $ 63,00 $ I
owned by me or a member of my immediate family, This I 201 to 400 amps (2) "$ 87,00 $ I
properly is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479,560(I), 1401 to 600 amps (2) $126.00 $ I
Signature: lOver 600 amps or 1,000 volts, see servjces or feeders section above I
1~:~:~~Nrts;:i~i~:~~~mIQN_i&~f;~~1 . : :r;::~o:i~:~~~ :::~~:I:~~::r:~:s:s:~na~:~::e:r feeder ree i
I Address: p. 0, 30lC +136/ I I Each branch circuit I I $ 6,00 I $ I
I City: Gux-. I State: 0/2. I ZIP: 7'7'10/ I I b, Feefor branch circuits without purchase of a service or feederfee: I
I Phone: oS", - ;}.Jil,/ - fi/r.GS , Fax: Os" I - 141- 1 o8S' I I First branch circuit (2) $ 55,00 $ I
I E-mail: SS;-I!IUO<.@.COMCAsT.fo.l6.r I Each additionai branch circuit $ 6,00 $ I
I CCB license no,: /'1"1618 I BCD license no,: 20- '-/12- c I Miscellaneous fees: service or feeder nO!included I
I Signing supervisor's license no.: .;:sS 1- i- 5 I Each pump or irrigation circle(2) $ 63,00 $ I
I prin, t name of signing supervisor:j;;;Elif 1-IfllkJC- I Each sign or outiine lighting (2) $ 63,00 $ I
I Signature of signing supervisor: . /J ~.. I I "Sign, al circuit or a h,oinited-energy panel, $
# a._..___ alteration, or extension (2). $ 63,00
I t.
I Each additional inspection: (I)
__1ll!(;:iG~1.1I(3-tl~E;RNI\IIEl':lmt~eeRQ'iJ.~I.~i.~1mfl'i:~
Zoning approval verified? 0 Yes 0 No' I
.mB!rti1,G~f:IOG~tlRYitlr;JIlc:~QNSmgl!J.G1I'IQN~~ .
~esii:lehtial I 0 'Government I 0 Commercial
_jffJPB.!l,Slil'E~IN1i0.8.M;;i1JIQNfANQ1IIl''-(';:hTt<:)N~~\~~
I lob site address: -ZJ'3L-7A7TH 5[, .
I CityDffC1:.N~p I State: Dr<.. I ZIP:"j:}4-17
I Subdivision:J1837~~ I Lot no,:
1~~t!l~PES~cR.ll'mfIQNI;tQl;lWtl~l:<~jl~i!j!5T~~~
lit NPN Jla.r5!f2: s-; F
I
~ce-~. W
\.~~q~K' P ~ ~rJ'
~~L,~
' .i...<fP ~ J
rfP~'~ .~
440-2584-J (9/08/COM) ~~
, $58.00
$
I (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
I (B) Enter 12% surcharge (.12 x [A])
I (C) Technoiogy Fee (5% of [A])
I TOTAL fees and surcharge; (A through C):
$
$ 3:};' era
$ 1.-5,4'5
$5t-J .13
~ ,~'.:, '
:.'
225 Fifth Street, _
SpriJlgfie!~,Oregoii- 9-7477 '
541-'J26-:1759,Phone",: ", ,,',
. .: :'f'~ ::"1<t:~:t~;'~" ':'.::~;:,,\~!:~'~ '
'. ;" ..,.~-
, RECEIPT,#:1200900000000001247
Job/Journal Number Description "p_
COM2009-01073 , " ,ResidenceW~i)ig'IOOO Sq Ft
i>", "~:'r.,.,..',l:,~.... "",,",.." ,:,.,,:,.....,...,,'~. ,'., .
COM2009-01073i;;,:,<:',)Residence'Wiimg Ea Addt! 500
l-~; ". c~; ,.....-.. -~
COM2009-0 1013'(:""(+,'12% State Surcharge
CQM2009-010l3,<:\ ;+ 5% Technology Fee
, .; .~o~) :;, t::-. ':.~.\~"',~
Payments:
Type of Payment
CreditCard
l.:heck Number
Batch Number
; .,.
Paid By
JEB MIRFS
Received By
"
"
.
','
:;"" ,-,;._"Z'.-,,~.....,<+.nI~Jt~:.:..
.. I; ~ : 't
, ,
.r't>.,~ ;.
, 1, " r,
't.
o 1;" .'., ,,~:,
.Ji ',+
,>
o ...c. ;~, .
.3:..."S;..,.....~.< :~::..:'::r~-::'.'"
, 'j"': i,
;! .~; :~. ':. '
; ..
ij \, ,
~I 'f "
if '~ i..
,. ,:
\;..'
.A'I;.'"
"
':'
,)
f..... .3.l~L'
~ ' !! .f , :'
<,
, ,.
~i \ >.
t,t !. f
.
,.
cReceintl ... 'L~ Page 1 of I
"
"
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 11/09/2009
[tern Total:
Authorization
Number How Received
051913 In Person
Payment Total:
10:20:40AM
AmountDue
134,00
175,00
37.08
15.45
$361.53
Amount Paid
$36\.53
$361.53
11/9/2009