HomeMy WebLinkAboutPermit Electrical 2010-8-26
225 Fifth StreettSpr;ngfield, OR 97477. PH(541)726-3753+ FAX(541)726,3689
DEPARTMENT USE ONLY
5./0' 00 /I.q
Permit no.:
Date:
<:;S-Zb-/<::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. '
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
esidential D Government D Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: \ z.. b Z. 3 S '5. +-
City: . S i>F b. State:04..
Reference: "ot 303L{ Taxlot.: 0 ~
DESCRIPTION OF WORK
$E1\.ot, '" .4.,J /7) C I /"c....":'
PROPERTY OWNER
Name: &erl r :;:Xtl~s. 1"'""""
Address: 3 Z? ~ 8'
City: 'U..~~
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).
rs
7 "1ytJ/
Signature:
CONTRACTOR INSTALLATION
Business name: $1E\.,a,~ E.LS::'TRlc'
Address:f'e? 130X hbp
City: fLC>99~ II-L- State:c::fC ZIP:<17LfSS
Phone:51-J.( ,?/f)..-;).oSo Fax:Sf/- 71.f6-0?;/il-
E-mail: .f..OGLLGHRN€!.)INISNfCd~
CCB license no.:'1'S'+7 (), BCD licenseno.:.:90- 3T3c
Signing supervisor's license no.: 'fo qt)-- S
Print name of signing supervisor: S1E\l13'l G a~
Signature of signing supervisor:
: regon a Ir 0
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952..001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telePhon~
number for the Oregon Utility Notificati \\0
Center i81-80ll-3J2-2344). lb'"
, ~~
440-2584-J (9!08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service inc'uded:
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) I $ 81.00 $gl
201 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) , ...~/;;>.;.::i;~ ~,ii~~;H ~'~~oo $
401 to 6 0 amps (2) '''0 \~, ~~ .00 $
{liVer'll< ~ ~~~ ;.e~iionabove
~e- .... --
n !)l, ~\l: _ -r'p~ne('
-~ , ~~%utO::",":,,_~urchase ora service or fe:der fee:
~ ~~h-/1ill8cil ~tcOir I I $ 6.00 I $
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit ID $ 6.00 $iO
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighling (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 subtotal of above fees $ /4 I
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ /b 'fZ
(C) Technology Fee (5% of [A]) $ ") e~
TOTAL rees and surcharges (A through C): $ J~I.{ II 7
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00147
1262 35TH ST
CITY OF SPRINGFIELD
225 Fifth 8t
$pringfield,OR 97477
541-726-3753
permitcenter@ci .springfield. or. us
RECEIPT NO: 2010000149
RECORD NO: 811-SPR201O-00147
IDESCRIPTIQN
Services 200 amps or less
Branch circuits with selVice or feeder each circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
A~_C9JJt:(LC9RE~ .
224-00000-426102
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
If>AVMENT TYPE
'PAYOR, "CASHIER DBOWLSBY', CPMMENT_S
Credit Card
083382
STEVEN R GEISLER
DATE: 08/26/2010
AMOUNTDUE
$81.00
$60,00
$16,92
$7.05
$164.97
<'AMOUNT PAID
'J
$164.97
$164.97