HomeMy WebLinkAboutPermit Electrical 2009-12-30
225 Fifth Streett Springfield, OR 97477. PH(541)726-3753 t FAX(54 1)726-3689
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I Date: I 2..- ~ 0 . a ., I
ElectHcal Permit Application
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
I:' , ' ' ': 'LbC:AL:~OVERNMENT :A~PRQVAL':"'1" .",","1 1;"')'/~'?"[*i'i'~:i,[j!';'i\f,EE~~scHED\jL:Ei:m#ij!'f";;l\1'j(~i~~~~iI'i:l~}~
I Zoning approval verified? 0 Yes 0 No ] I "Num~er.iif.Inspeciio'nKp~r,I!~!~l(), :,,[Qty.I'.., ~e,oas~ :,1 .'~, ~ts'atl,: ,,[
k2<CATEGORY;:OFC()NSTRQCtION', I"'" ," ,', - ,
i~~~~~~~~:~'TE"'N~~R~;~7;N~;ANP::~~7;~~~~~~.~rpl :~~~;::ti:I':,~:s:::; service include\ .. $134.00 $' J
I Jo~site address: \ L:<' I"'te \ l\d;~o,J ' W -..II I ~~~~;ritional 500 sq ft or portion I $ 25.00 $ I
I City: Soc;,,<-.\":e.\ol I State: 0, IZIP:_CnLi711 I Limited energy (2) j $32.00 $3a
IReferenc~: 110S(~O, ,ITaX,l,o,t:C;>fIU( I I Each manufactured home or modular $63.00 $ I
I" DESCRIPTION,OF WORK ",F"" dwellmg service or feeder (2)
I D I ') - 1 \\ I Services or feeders: installation, alteration, relocation
o....rr^- l_OLh -e \,^_~Ic...
I ''fl,." -\'A Ce""" i-t (" I 200 amps or less (2) $ 81.00 $
I - PROPER;ry .oWNER I I 20 I to 400 amps (2) $ 95,00 $
I Name: Pec..c.e 14(<>.1-1-\...... I I 401 to 600 amps (2) $158.00 $
I Address: 1'2.3 I,.,l..':( """+"""",,,- l W'-i I I 601 to 1,000 amps (2) $205.00 $
I City: Sor:v-.c t; el) I State:, Of I ZIP: cn~:z.1-l 0\ .i6ver 1,000 amps or volts (2) $469.00 $
I Phone' ~ -l.......!iI. OtegQllIll'lll' IV.,O IT: 01 U .ili\fonnect only (2) $ 63.00 $
. ..,-rRn~' . d Iil" \1:1" lea .Il..n
E-mail: . tOt'ow ~'e. aa~\" Tho'se rule! are ~e). CP~~porary services or feeders: installation, alteration, relocation
~I^..G~ . !lMMhj'\-ll5~ ~Ho.amps or less (2)
This installation is being lI1Il8<> '\lOOf&M\~nl"'s'6Hhe IU o~"l\v $ 63.00 $
owned bJ: me or a member IIf I ~ llQIp,lBS t IE P ~ to 400 amps (2) $ 87.00 $
property IS not mtended forQe90e e=. O\l'lotJ3d!\f{ e . '
479,540(1) and 479.560(1). callIng '"(;8900 Utility NO\f'cf~\9f'to 600 amps (2) I I $126.00 I $
Signature: '1\Ym\)8\' ~~":~181.s00.332-23441. I Over 600 amps or 1,000 volts, see services or feeders sectio~ above
I .." '.' 'CONTRAC;T.oR'INSTALU\T10N ,'I I Branch circuits: new, a{'''ation, extension per panel
I Business name: n fA +. ~ Ov\.o...\ Y1-e ~ WtH j( _Se.I";I'(~ ~ I a. Fee for branch circuits with purchase'of a service or feeder fee:
Address: 3D'Z.. ..<;'h, II ev S+( , :J:1 b I 1 Each branch circuit I $ 6.00 I $
City: So r:-.. ( j:'.; e, Iff I Suite: 0 ( I ZIP: q, tJ7? ] I b, Fee for branch circuits without purchase of a service or feeder fee:
Phone: 9-1~ 72.k ~ q 2.09 I Fax: I I First branch circuit (2) $ 55,00 $
E-mail: I I Each additional branch circuit $ 6.00 $
CCB license no,: \ 5l.f 3CD I BCD license no.: ZO- 3/:') C~t=t Miscellaneous fees: service a, feeder,na' included
I Signing supervisor's license no.: 4<.41 L t A I I Each pump or irrigation circle (2) I, $ 63.00
I Print name of signing supervisor: 3c:.oH- l+olA..S I e1 I I Each sign or outline lighting (2) $ 63.00
I Signature of signing supervisor: / ..,J... ) } d I Signal, CIrCUIt or a limited-energy panel, $ 63.00 $
Acn-tA.- ftJtL/1A'IM ~ alteratIon, or extensIon (2)
( _~ac~.;,~,~~~i~n:1 i~s~ectinu:~), " . . $58:0~.. $ _ I
t~ ~ ~'~I,;'!~~~:~:=AReLl~ANT'JUSE~ ::,:, ;';' ~*, "'; .:-
\ra:~l/SJQ/ ~?\?-~~~~"I~9! ", Fee$58.0~ $ 58
~\~~WlY'i S\\f>.\.\.i-'i\-\\S ?~~~.oa%'$u;:charge(12X[AJ) $ b''''
',\\\S ?~I'-\l't.'i) \\~'i)~s f>.'Of>.~~~I:hechnOIOgy Fee (5% of[AJ) . $ Z'O,
1\\\,\1 't.~C,'t.\) \)1'- \\)'i). I TOTAL fees and surcharges (A through C): $ b 7 t3~I)
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440-2584-J (9/08/COM)
A
225.Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1260
COM2009-0 1260
COM2009-0 1260
Payments:
Type of Payment
CreditCard
cRcceintl
RECEIPT #:
&P~:Q"-;U>jj
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City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001366
10:34:0IAM
Date: 12/30/2009
Description
Low Voltage - Commercial Indus
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SCOTT HOUSLEY
Amount Due
58,00
, 2.90
6.96
$67.86
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Paid
djb
$67 86
$67.86
074496 In Person
Payment Total:
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. 12/30/2009