HomeMy WebLinkAboutPermit Electrical 2009-12-21
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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
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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~
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440.2584.) (9/OB/COM) '..::: ~ ~
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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
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cReceintl
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12/21/2009