HomeMy WebLinkAboutPermit Electrical 2010-8-13
FROM
Electrical Permit Application
. - .
CITY QF SPRINGFIELD, OREGON
225 fifth Slrcct.Springtield, OR 97477. PH(541)726-37SJ. FAX(S41)7'Z6-3689
(FRI)AUQ 132010 14:44/ST. 14:44/Ho.761SSS$14G P 1
liPAIHQPIl!LD;
~.,
"r1,l~~~R!M~~rUSEO~l Y..
10
S1
P. /:..
,ermlt no.:/ I
Date: "J~(<.J
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
'L(DC~L"$(!jVERNMISNt,i!~(;!ii!R!D,V,~U!!ii!illWm .. ...... .
Zoning approval verified? 0 Yes D No
.... .GA'tr:E$OR:('.OE;'!CON$mRJil.Qllf(!!!N~.i:i!:mm:,',,!i'i'Wl
esidential 0 Government 0 Commercial
JbB;Sll'EINf'l:llRMAtloNm~NPm:illitl:q);l1'loN1-
Job site address: g,S
City,
'-
.. """;:i:! ;:!!:!~:ir~:~_~p;i;'~/'~~iHQ,wN.t:Rii!!l~Hj~mmlilr~:i!!:jm1!w!mj!1::m~:!:1!:i~i
N~me:
Address:
City,
Phone:
E-mail:
This installation is being made on resl ial or farm property
owned by me or a member afmy immedia mily. This
property is not intended for sale, exchange, leas
479.540(1) and 479.560(1).
Signature:
. CONJRAGTOR::lrilSJ1\l!~rmON':'
,.~.......,,,,"......,'
,,",,,,.;;,,~.,,;,,,',::' ;
;"i':;;;;;:~!;UJ;:;"
Signature of signing supervise ,
~~fJ
~tV~V
~~
44U-2584-) (9108ICOM)
i:'~~~~:~~i~~I:!l!I~~~L,,:1,~~'~i~~~)~~~~~~'t~W
Residential, pel" unit, service included:
1,000 sq. ft. or less (4) $134.00 S
Each additional 500 sq. n. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each'manuftlClured home or modular $ 63.00 $
dwelling service or fi::eder (2)
Services or feeder"s: installa/ion, aJteratiOlJ, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amfl' (2) $ 95.00 $
401 to 600 amfl' (2) $158.00 $
601 to 1.000 amps (2) $205.00 $
Over 1,000 amps or valls (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: instal/alion, altera/ion, relocation
200 amps or less (2) . $ 63.00 $
201 to 400 amfl' (2) $ 87.00 $
401 10600 amfl' (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section abow
Branch circuits: flew, a/ferallo/I, exte,~;'ion per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each bnmch circuit I $ 6.00 I $
h. Fee for branch circuits without purchase of a service or feeder rec:
first brdnch circuit (2) "1 $ 55.00 $ E)S'.cQ
Each additional branch circuit :I $ 6.00 slf>' '"
Miscellaneous rees: service or feeder not included
Each pump or irrigation circle (2) $ 63-00 S
Each sign or outline lighling (2) $ 63.00 $
Signal circuit or a limited~energy panel, $ 63.00 S
alteration. or extension (2)
Each additional inspection: (I) $58.00 $
'1"\:~""'i";ni1"1'i!I. !""'illP:"~I;'ill#lr"'IJlf""'T""" '''j'' ." ''''.,.W1........'/!','''IW.'I'llllfllf 1li!1l"ll'llmll!"lll~I'tl)ljf"
iJIllirJiH~l Hil1!!I.~ilmi~m,'ii;:im~{,1illlil ~,. ,iJ!U.Ci~.N.ia'm~.~.el!ii1jjlij~h!i;,iliiiilMiW:11, Hii\lidiiiil:J,iF
(A) Enter subtollll ofllbove fees $ ~1.dJ
(Minimum Permit Fec 558.00)
(B) Enter 12% surcharge (.12 x [AI) $ i.3?...
(e) Technology Fee (5% of[A]) $ :'.15
TOTAL fee, aod ,orcharge, (A through C): $ 11,3'"
~
~.
FROM
lVi:~cha'nicaJ Permit Application
I .
CITY OF SPRINGFIELD, OREGON
. .
225 Fifth Street. Sprin~field, OR 91477 . PH(541)726-J753 . FAX(54J)726.3/'iR9
(FRI~AUQ '320'0 '4:46/ST.'4:44/Ho.75,SS5S146 P 2
.~i::j:i'R~~~~m~~~mi'Q~,~:pN4Y" .'
Permitno81 ~:5Q - SO;
Date: <;5- \3 - /AJ
This permit is issued undt!r OAR 918-440-0050. Permits expire lfwork Is not started within 180 days of issuance or if work is
suspended for 180 days.
"QA:tggqR'Y"q.~':'i~~f;j$jjjB:i!!:q[,i~!K~j:::::m:!i!i"!:::,,!,:'.1
Job site address:
City:
Reference: Taxlot.:
.... "':b'ESCRipjj;iql\ii:QEE::W:Q~~ .....
"'".""",
-,,,h ",.,,,,,._,.
'""",','.' "li"
.. ......
d;ij~fff{Qf};~:R~~lli',QWN:~:B;!i!!~mmm~W!!jjm![Will!:i~1g1:mmw;~m-
Name:
Address:
City:
Phone:
E-mail:
This lnstl1l1ation is being made on property owne
member of my immediate fami-Iy. and is exempt from
requirements under ORS 701.0 I O.
Signature:
.., Ie :::::!Uc.~QNm:~~,:tt9R!!:'!,I,~:~J1~~!~mrqiN::m~~~j):i!!!i~m~i!iUi)lp.lmg!!!:
Business name:
Signature:
440-2545-) (I 1 illS/COM)
J
First A liancc
urnat:elburner induding cJut:ts amI venb
Up to lOOk BTU/hr.
Over lOOk BTU/hr.
Heaters/stoves/vents
Unit heater
Wood/pellet/gas slave/flue
Repair/alter/add to heating appliance!
refrigeration unit or cooling system!
absorption system
Evaporated cooler
Vent fan with one duccJappliance vent
Hood with exhaust and duct
Floor furnace including vcnt
Gas i in
One to four o\ltJelS
Additiollal outlets (each)
Air-handling unils, including duct,
Up to 10,000 CFM
Over 10,000 CFM
Com ressor/absor tion s
Up 10 3 hpll OOk BnI
Up to 15 hp/500k BnI
Up to 30 hp/I ,000 BTU
Up to 50 hp/I, 750 BnI
Over 50 hp/I,750 BTU
Incinerators
Domeslic incinerator
.. ,..,,1
';,':',TotaJ
.., ~:'tos' '
$
$
$
$17.00 $
$38.00 $
$58.00 $
$13.00 $
$9.00 $
$13.00 $
$58.00 $
$
$
$ / '.Q.l
$
$17.00 $ (
$29.00 $
$43.00 $
$57.00 $
$95.00 $
$
iiqQ,mm~r!;l~~~!!Wiw:mmimi:j!:;:~m!';:ii!:i:~il!!~:jW;;-:i!!!:j: !i;!~!H::!;,~ /1 ,"/ '; : /1 . '1 :i:'~!:!(
Enter total valuation of mechanical system
and installation costs $
Enter fee hased on valuation of mechanical system, ete. $
i~1M11li 'Iii WHim"I'I'ilJ~llliiWlI'llili>lill::'lj~lli:ip.liJir;I"li!i!nli';i;i!i !';f:;~ii;:iqg;~:iit ip~,'ii €.ost!"~iic :~:'ra; ci't'iilli;:::
m":",,,~:1r.~'l~~i,Ql.e:~i~ll!""I~!Ml!!fi!~LMmi!W;W:m!l:iim ~f:~!~;;, ~!~~t;reiiE~:;;;~~ mN!:'~05ti::!i':
Reinspection $58.00 S
Specially requested inspections (per hr.) $58.00 $
Regulated equipment (unclassed) $13.00 oS
Each additional Inspection: (I) $58.00 S
'.". .." . ...., '1 'I''' '..,,,....,.,.-;;;.....'......-."'"'1"'..'..1"1 "cr,' ..."".",.""",,,
;'iW~!: ,jYi,~mr. . R! ~ !:I ., ,RmtNlU)~~L~I!I!!.w~U::!!ljDi mdMillHu :il~H Ul:jj1tjgi!:ii!miii~
(A) Entersubtotal of above fees (or enter set
minimum fee of S Ii..Q2)
(B) Investigative fi:e (equ.ltn [Al)
(C) Enter 12% surehorge (.12 x [A+B))
(D) Seismic fee, 1% (.01 X [AD
(E) Technology Fee (5% of [A])
TOTAL fees and ,urcharge, (A through E):
$""i.~
$
$
$
$
$
q1--t{~
S;.~~N~E~~
~~
~'OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield, OR 97477
541.726~3753
it:
WNW.ci.springfield,or. us
"'~'i.t.:,. -
"f"1~:~ ':I~"c..
", ..
permitcenler@cLspringfield.or.us
"'" {'- .'-',
RECEIPT NO: 2010000066 RECORD NO,,81I-SPRZOIO-00059 DATE: 08/17/2010
I DESCRIP;!iION , , , ',.;",.,~,:L'F;,;'" L" ,"'""'r"";' ,," " ,:, ,\ACCOUNTCODE;,"~:i~\ +AM0UNT DUE "',,,')
L.!:!..I: _~~Ai..~~.. . .. .', _._ _~ '~~~'._ "','. ' _ ., _ .." ... _ ____________.__.....J
First Appliance Fee 224-00000-425604 $79,00
Branch circuits with service or feeder each circuit 224.00000,426102 $6,00
--~-'-'~'~
Branch circuits without service or feeder - 1st circuit 224,00000.426102 $55,00
State of Oregon Surcharge (12% of applicable fees) 821-00000.215004 $16,80
Technology fee (5% of permit total) 100-00000-425605 $7,00
, ' TOTAL DUE: $163,80
~_,f'AV_MENT TYPE""'j:iAVOR'", cA, S.HIE,R, N, MA" CH,AD, 0;,/, :'C", 0"-,111' fII"E,N"T,',_.'S," " ":';, :/>:,'" _'i'" "':-:ANibu' NT pAID';, 'j
~ "M . -,_. . _' -... ... ... .- -. __ ~'., "~'''''''''"''''~~_..__.",,~,_._.~.._..'___--.;..._.:...t.!..,
Credit Card HOME COMFORT HEATING &,,:': , ',;; $163.80
AIR CONDITIONING :i ',',i, ;> : . -.
017482
i
'.t .~.-':~ .
..:,,:,~. :1;.:J., \;
'1:.\
,...-.,_.~,_..r
"'-~".'~'7 '.,
-f,-!~
,"\')jli'
'of'
;.,
, ... ; ~~....';
; j,1' ~e.i::" :'
i..:-'
.. ".
: ,~
":.
~:';'\-';.-
>;(;. ;::h j
+;7?;;
.~ '.~.,.~,,~'~': ....
,.
, , t; 'i.~\i." {J: ", '.
;1 '.\