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HomeMy WebLinkAboutPermit Electrical 2009-12-21 :::' . ~ " I Electrical Permit Application CITY OF SPRINGFIELB! OREGON. 225 Fifth Street+Springfield, OR 97477+PH(541)726-3753+FAX(54I)726-3689 ..PR.NO...... I"" DEPARTMENT USE ONLY I k~ l'pennitno,:Cq _9174-31 I Date: /'~/d-II d=1- 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. I FEE SCHEDULE I I,Num~.erofinspections:,perJtein(). IQty.1 ~t ~~~~I I I Residential, per unit, service included: I 11,000 sq, ft. or less (4) $134.00 $ I I Each additional 500 sq, ft, or portion $ 25,00 $ I lhereof . 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 $ I I 20 Ito 400 amps (2) $ 95.00 $ I I 401 to 600 amps (2) $158.00 $ I I 601 to 1,000 amps (2) $205,00 $ I lOver 1,000 amps or. volts (2) , $469,00 $ I I RecOnnect only (2) $ 63,00 $ I 1 Temporarj services, or fee~erS_:;'~n~tl!{lq!i~n, c:{tera~i.01!,.re~oc~~p'!.n I I 200 amps or les~(2) " "'. .' $ hoo, $ I 1'2jJi ;o'1bo.\impsi2r~~'.. m. ."....' $,87.00. $., _ _.1 I 401 to 600 amps (2) ...-:',.:':' ':..'.':~';;_'I'''i: I $126.00'$" I I Ov~r 600-amps ()f 'i,ooo volls, see services or feeders section 'aoove. I CONTRACTOR INSTALLATION .I I Branch circuits: new, alieration, extensianper panel' I I Business name: (OM D z.le..cl.~c.... Lc... D I I a Fee for branch circuits with purchaseofa service or feeder fee: I I Address: ~6 ~QX. 7ck)..o b I I Each br';;ch circuit ' I I $ 6,00 I $ I I City: 0~V\.e...... I State: o~1 ZIP: . I I b.Fce.forbTllnchcircuitswithoutP~chaseofaserviceorfeederfee: I I Phone:S't1 -7'f1-'7"i~9 I fax'/',Lfl' - 9~-fi'ool I first brnnch circuit (2) , ' I I $ 55,00 I $ I E-mail: 3M..:).....\~lc...CD-- I I Each additional branch circuit .2 $ 6,00 $ I CCB license nO'::#~/q 1 I BCD l:'j:!eJS-.;b':S3;r"J J MIScellaneous fees: serVIce ar feeder nal mcluded 1 Slgnmg supervisor's license no.: # J ~ .... I I Each pump or lrngatton clfde (2) I $ 63.00 I $ I Print name of signing supervisor: 1Y),J,;,.e..; Ie::: :c.o<.V~S I I Each "go or outhnc lighting (2) $ 63,00 $ I Signature of signing supervisor: I I ~i~~I~~C~~\;~:nl~~~(5.)energ)r p~el, I $ 63.00 I. $ I__E;~h 'sddi'tional i~spectioD: (I),. .. 'I .$~8.001 -$: ~- 1:;:-.. ; .~~".AF'PLlCANT' USE I.V\) Enter ~llbtotal:6fabove tees. , (Minimum. PennitFee $58.00) I (8) Enter 12%'suicharge (.12'x [AD, I (C) Technology fee (5% of[A]) I I TOTAL fees and surcharges (A through C): I, LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes D No CATEGORY OF CONSTRUCTION.... o Residential I D Government _ j ~ommercial JOB SITE INFORMATION"AND LOCATION Job site address: dSv ('Lv.; ~MQ v'--J S~ \' City: =r' \ dol State, ()(l.. I ZIP: Q7'f 7S" Reference. I Taxlot.: DESCRIPTION OF WORK 8d.d,:"'a (..i) ~..":J,, c.,c.;..~u;+s- -<=V 12.f/U.~c..~~ '\- l.c.42sh.e.r-'\ I "', IIROPERTY'OWNER. , I Name'~1'VIoh-l.'!.OM.E'\'.':1. ,s.r.~ I Address; <:::::\ '""'\ I City: I State: I ZIP: I Phone: I fax: I E-mail: This installation is being made on residential or fann property owned by me or a member of my' immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479,540(1) and 479,560(1). Signature: #~C;/~:::<'~9~. 7~(7:f~ .~~~~~';~ 440.2584.) (9/OB/COM) '..::: ~ ~ I I 1 I I ,I , ":$ll'~ -(11) ,- ,CX.,l . _.~. " $.' . (flO ":'~~~1 225 Fifth street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Developme!lt Services Department Public Works Department RECEIPT #: 2200900000000001412 Date: 12/21/2009 ]:2S:12PM Paid By G,M,D, ELECTRIC Item Total: Check Number Authorization Received By Batch Number Number How Received Amount Due 12,00, 0,60 1.44 $14.04 Job/Journal Number COM2009-0 1743 COM2009.0 1743 COM2009-0 1743 Description Add, Alter, Extend Clrc Ea Add + 5% Technology Fee + 12% State,Surcharge Payments: Type of Payment Check Amount Paid njm 3787 By Mail Payment Total: $14,04 $]4,04 ~,,~, l" cReceintl Page 1 of 1 12/21/2009