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HomeMy WebLinkAboutPermit Electrical 2010-8-25 Electrical Permit Application .crd bF.SPRrNGFrEED;~OREGbN.-: '.'tJ' ~:'\'.-;~ ~ '<.r:'.t,,I. ,-If'f; r. ~ -:.;- ., _.,'. ,,,,_ ,;;.,;....~ 225 Fiftb Street. Springfield, OR 97477+PH(541)726-3753HAX(541)726-3689 SPAINGFllf!LD ~. DEPARTMENT USE ONLY S~4210 .00/'1 Permit no.: Date: 8~?.s-IO This permit is issued uuder 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. ' LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes D No CATEGORY OF CONSTRUCTION esidential Reference: Name: Address: City: Phone: E-mail: This installation is being made on residential or farm 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: CONTRACTOR INSTALLATION Business name: S1E\,a,~ "E-~R\C Address:fO BoX hb? City: fLc4lS.iNJI II.L State:c:R ZIP:9 7Lf-~S Phone: 5W '?tf)..-;).I':Xi"O Fax:31/- 7<f6-0'!;/ 0l- E-mail: .f'OGLEGH RrJ €E) vV\SN f Cd Vi' CCB license no.:Cf~:A7 CJ, BCD licenseno.:.:90- 3T.3C Signing supervisor's license no.: 'fo q4 - S Print name of signing supervisor: sTE~'EN G 13~ Signature of signing supervisor: ATTENTION: Oregon law requires youto follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-001 0 through OAR 952-001- 0090. You may obtain copies of the rules by ~ calling the center. (Note: the telephone " number for the Oregon Utility NotificatIOn i\ (\, .\. 'v Center is 1-800-332-2344). V{~~(J.J 440-2584-1 (9108/COM) \'\~ FEE SCHEDULE Number of inspections per item () Qty. Cost Total ea. cost Residential, per unit, service included: 1,000 sq. ft. orless (4) $134.00 $ Each additional 500 sq. ft. or portion . $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 20 I to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) 201 to 400 amps (2) 401 to 600 amps (2) $ 63.00 $ $ 87.00 $ $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new; alteration, extension per panel a Fee for branch circuits with purchase of a service or feeder fee:. Each branch circuit $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit I $ 55.00 $ sS" 2 $ 6.00 $'2 Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal cirtJin.;fMli!>>lt~~:energy paoel, $ ~~~~,\, '$ aIteratloo"o.!i~te.'J81on"".. <:U^' t t:' DtR li:i:i~j:, ,nQI( Each addi!i~~~\',i' . ~ T HR ~ FRMPJD9c ~OT .: r.nMMI=~1 .~,~ ilSE1nhll=n FOR ..' .::' (A) Ente(siMo$Btffl>,q,e"'~flJOD'$ /7'" (Minimum Permit Fee $58.00) C> $ S Q'1 $ 33~ $.., ~J' , (B) Enter 12% surcharge (.12 x [A]) (e) Technology Fee (5% of[A]) TOTAL fees and surcharges (A through C): . . . Slr.~.EL~ ~~ ~O.REGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00146 2540 0 ST CITY OF SPRINGFIELD 225 Fifth 5t Springfield,OR 97477 541-726-3753 permilcenter@ci.springfield.OLUS RECEIPT NO: 2010000150 RECORD Nil, 811-SPR2010'00146 DATE: 08/26/2010 !OESCRllfiIONT'-j":;.:: .;.;4":;'~jJ=-1'4,jj~~' ~;:':~~:~,,*,".'7!,"j:::~ci:.QU~jlG:Qi:lE;'i,;'i;,;';t',: .~MQl)t:ftJ!UI:~j .,. 'r'.,,;1 Branch circuits with service orfeeder each circuil 224-00000-426102 $12.00 Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 ____ $8.04 Technology fee (5% of permit total) 100-00000-425605 $3.35 TOTAL DUE: $78.39 ~PAYMENr;;t-YP.E'~-:eA'yOR~CAi;HIER'QB9)M'~B~-\;;iffQf11ME.f:!'[S:~f:l\~4;~.' ~:;'!-~i:1Ethie.J~_Q.\!JH;f,~:I!)..Q:-!-,.'.. . ."....1 "':;~k~::' .:~' ... '. Credit Card 474917 STEVEN R GEISLER $78.39 $78.39 i:: ~ \. '...): '~~. '. < ii. ,; f.' :f~f~~; ~,C{)i'~:d~;l.:. .:'~ ~f. .e.' . ""i.--" 1', ~.'. ^. ( [. ' :~,~) ,:': : ._~~ "1 .:~.:. ." ' ., '/'1. ":~.,~"";. ,:' ~