HomeMy WebLinkAboutPermit Electrical 2010-8-25
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Electrical Permit Application
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eITFOF SPRIN6FIELD~,()REGON .
.,,\f.-'(~";' l-"~ -, .l<i'+..~~.> ~ _," ~"."d ;;....' -'l" , :<=.-"- <~d.;".
225 Fiftb Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
DEPARTMENT USE ONLY
S~,eIO'OO )4/
PermIt no.: .'
Date: g-2S-/0
Tbis permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days ofissuance or if work is suspended for 180 days. '
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes DNo
CATEGORY OF CONSTRUCTION
~esidential I D Government I D Commercial
JOB SITE INFORMATION AND lOCATION
Job site address: /z62 '3.$+'"
City: . -:.rF~ I State: 4L.... I ZIP:' '1(7 7
Reference: ) ., 0 Z "3. 0 3 'f I Taxlo!.: 0 9tuc
DESCRIPTION OF WORK
Se(l..IJI(.G: IF C'rc....-:-h
PROPERTY OWNER
Name: II Lo.-; t/ r :x#ptSrwtt;ln;. LLL
Address: ~21 (:. 8~&... ,4V~
City: ~c.-e-N'~ I State: C>i- I ZIP: 97<(01
Phone: - - I 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 ren!. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Business name: S1iE\JEWS Ece:::TR\c'
Address:fO BoX bf,3
City: fLc-l9S.~'>f\lI !+II-L- I State:c::::R I ZIP:Cf 74-5"S
Phone: 5 'if 9'1 f).- ")05"0 I Fax:51/- 71.f6 -0 ~f [}..
E-mail: -POGLLGH RN @ vVlSN I cofrf\
CCB license no.:Q!::>47 CJ, I BCD license no.aO-3T3c
Signing supervisor's license no.: ifocrl}-S
Print name of signing supervisor: STEveN Ga~
s' f" . ~ 1.:r\lj
tgnature 0 slgnmg supervIsor: \"f'\..
~
ATTENTION: Oregon law requires you to ~
follow rules adopted by the Oregon Utility ~
Notification Center. Those rules are set forth (\~ ~
in OAR 952-001-0010 through OAR 952-001- (\~ 'oJ
0090. You may obtain copies of the rules by V\
calling the center. (Note: the telephone
number for the Oregon Utility Notification ~
Center is 1-800-332-2344).
440-2584-J (9/08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq. ft. or less (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 $ 8/
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) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see service~.pIJeeders section above
Branch circuits: new, alteration, exte ' lliir'l'-
- ~
"ir~erMi,B;'0~7{i~\!iJ;WItPu'tc~-& 'OHJeder fee:
lEath IY~Ji,Jfr;~jf~"i.l\'\Dt.R \;':~\~nl~t.D ~'$"'6.00 $
b. IRbb \fOr\'bt~~ct9R W'fl.1~U~ pu~chase of a.serVice or feeder fee:
_.IIRC.\\\ ....
';\l\"IIV'..... . .'I~t\\U'"." $ 55.00 $
F!~f\~rrvwr. cCfFWt
""1\1' . Ie $bC
Each additional branch circuit $ 6.00
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
. APPLICANT USE .
(A) Enter subtolal of above fees $
(Minimum Permit Fee $58.00) 14 \
(B) Enter 12% surcharge (.12 x [AD $ /6 r
(C) Technology Fee (5% of [AD $ ;c.S'
TOTAL rees and snrcharges (A through C): $ /I u"C\ J
, 101 ,
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www.cLspringfield.or.us
TRANSACTION RECEIPT
811~$P:R2010~00147
1262 35TH ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permilce nter@cLspringfield.or.us
RECEIPT NO: 20 I 0000 149
RECORD NO: 811-SPR201O-00147
DATE: 08/26/2010
tPESCRI~fIO~NC'!V;":~~'~,:~'0t~,i!~::4~,~D'~:h;:;{t_':""~'k~~:k*~~~~f;,,,~_~i~f~C.C.QUNtLCJ:>.p~~,~3?lr,:rt~;;~~MQUijj~Q.UE::~~~~:ti;A::~]
Services 200 amps or less 224-00000-426102 $81.00
Branch circuits with service or feeder each circuit 224-00000-426102 $60.00
_ ____w_c ~_
State of Oregon Surcharge (12% of applicable fees) ", , ." 821-00000:215004 __~
- .... ~.
~Iogy fee (5% of permit total) \;, '.-. 100,00000-425605 $7.05
.;, ".-, TOTAL DUE: $164.97
1ifi!I1AYMENj;;rYRE!1f;'",:TpAY:6R:fi*S%1i:AsHiER~6BoYJCsilYj~;G..0li1M~III[$Cii,;:".~;:i'I~'~,}::;;;r,~:iAMO(fNTJPAID-,).;;.:;.'..- c'-.:x 1
Credit Card
083382
STEVEN R GEISLER
$164.97
$164.97
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