HomeMy WebLinkAboutPermit Electrical 2010-8-26
.
225 Fifth Street+Springfield, OR 97477+PH(541)726-37S3+FAX(S41)726-3689
Date:
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.
~:,~~\,[fj\M:'()CA1:l:~:GOVERNMENT;!{APPROVAlJ"t',;'!Ii~:.' "~,I"~
Zoning approval verified? 0 y' es 0 No
': ;,';Z;';'f1"i:lii:{CATEGORY,,:0l1ilCONSTRUCTION:;",.,> ,,,;,; i'"
D Residential I D Government I D Commercial
,:'l~;l';,?JOB;-SITE;,:INFORMATION",ANO ,tOCA TION:,' .,\', . 1,000 sq, fl, or less (4)
lob site address: ,,? 33& (a-/Ik...L ~/:' J ~~~~;?ditionaI500sq,fl,orportioo
City: State: ZIP: ( , Limited eoergy (2)
Subdivision: \r')I~ 1)/\ E ~l) I Lot no.: (~\C\C. L,..I Each manufactured home or modular
i\";),;'!i';'~:;,1";~1':l~DESCRIP,T10N,,\0I1:)WORKf,~{,";i;l~"',,:,,;,_ ",' dwelling service or reeder (2)
I/,>,,;,,~ 1- <Z,n F,tJ / Or. /1-_
1
~ ~o-nER...v'ow NER"''''''''''~C'/'-'"-f'"'.'
~'r:~:\~ t.";,' ~'17 _', U{;c - _ ,_ "fiY_IiiM'.',:~~~~'::,."1't~~,,,,:;,,,'~A:-,":_kf~\:i
Name: ~") L .J A-\ D b( \ .'""Yl:J u' L '-".
Address: tQ. ') 'fl1.p \. ~\ \" ~ \
City:, A~\D.\\CI !11l\~ State:?)fL-.I ZIP:C\~\
Phone: \1)4 ( (
Fax:
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:
',,~,;<;"'''f.;:CONTRACTORSINSTAL'.I1.ATION)9''';:'i''' '.' ,;,,'
. ... ... .t""" \.. ..., ~__ .. ... . .. ......- ,.,' -. . . . , ,... .~" ."'," . ;"~"'>',,,,,,.",,/,-, .':.
Business name: !tDll (1)() 1 J r I. /IT" . ;.
Address: -(JD /J. ~ / _'? I t=:.'!J3
city:h I /"JP />iO State:!'r1', I ZIP({7t10:;L
Phonc,6'-JP -t.'Rt:,- ~~ -;;;;] Fax~U I /---Ph -~-'1J.t;
E-rn.il:! /,Ti'O/.t:) ~n..L'Vi/lnln"-r..;... ,/'/1J1I'-.,
CCB license no,: ."')711 l? ~ BCD license nobD-/ <i5r'.
Signing supervisor's license no.: _l:);:>5:;;.s
Print name of signing superviso". li,.<:.. 7;./ <;L/
..-/. ~ -
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(\'v &lY
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Signature of signing supervisor:
I/O. .
I
440-2584-J (9!08/COM)
;.S;:~~,~:~:',~'~:!,I;,t{\. ".,.:i:~~' ~~LFEE"~SCHEDULE
"C," ..''''''"-;''''~:D':', :""');;' ;:"r :":("';,;;~~'\",~_i".,,: . ',W ,'-\ :"..f Ie:"" ..
Numtler;'u'( inspec'tioDsper item N Qty"
~J:;"':,~. .'..,::-,_:"';:;;~i;':i_:"" .,:.":~,;ci::"i'..1'. '.:.','.'-: .,--, ''-:'''' ;..:' .,;-'.o
Residential, per unit, service included:
"
Cost
ea.
I
Total :1
cost
$134,00
$
$ 25,00
$
$
$
$ 32,00
$ 63,00
Services or feeders: installation, alteration, relocation
200 amps or less (2)
~ $ 81.00 $,W _
$ 95,00 $
$158.00 $
$205.00 $
$469.00 $
$ 63.00 $
201 to 400 amps (2)
401 to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 ainps or volts (2)
Reconnect only (2)
Temporary services or feeders: if!stallafion, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
401 to 600 amps (2)
$ 63,00 $
$ 87,00 $
$126.00 $
o'ver 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
$ 55,00
$ 6,00
$
$/,~
I/I"J
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2).
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
altemtion, or extension (2)
$ 63.00 $
$ 63.00 $
$ 63,00 $
Each additional inspection: (I) $58.00 $
ia\\;~";\\~\rt~t.~~~~~J:i:,\)S~i,,-~"'fA;I!-.-~'L';"I"'C- ...'A"'-N....T" .rtu-.:--'-S--..E-----'-;;-~~~}:'~;\"~f\\'J,;;;,'s.,.".t"<','i',,-.""'~'l\,','I'll
L:"{~*,,.p;:_;:..""'...&;i'm>,:'ii,;:;:;~~1\\#;1~~1'\ "ro;-.... ::f'. .}~,J~:'l5..!:jyt"\-.J:jNh\r,,,.f.~dtmU
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
$
(8) Enter 12% surcharge (,12 x [A])
(C) Technology Fee (5% oflA])
TOTAL rees and surcharges (A through C):
$
$
I( $';.c;U;
'-- (
1-
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"OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00156
3336 Gateway ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541~726.3753
pennitcenter@d.springfield.or.us
RECEIPT NO: 2010000142
RECORD NO: 811-SPRZOIO-00156
DA TE: 08/26/2010
224-00000-426102 $162.00
224-00000-426102 $60.00
821-00000-215004 $26.64
100-00000-425605 $11.1 0
TOTAL DUE: $259.74
~~i!'eAY;MENj"5'iiYRE[~1[mUF5BAYoftml!llf:lUi'C~HiEil8~M~Q~O()~i!!h4llcciMMI;NIsmllli1Iti!!iif,if%ifi!J~ill1i1~lfliAMOUNIi.F1AiDl~i~[~im,1!ili!i'ii"11~
Services 200 amps or less
Branch circuits with service or feeder each circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of penmtt total)
Credit Card
216292
NEW WAY ELECTRIC INC
$259.74
$259.74