HomeMy WebLinkAboutPermit Electrical 2010-8-27
Electrical Permit Application
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CITY OF.SPRlNGFIELD;.t>REGON~i;
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225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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eO. riE~~,RTMENT USE ONl V
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Penml no.:
Date: 3/2--7 /0
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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.
. "1l0CAl:GO\lER/IlME/Ilr '.APcRROVA8i[*,~W;;f""'\1'\r
Zoning approval verified? 0 Yes 0 No
\';: :>;.ti;,.;:'ICATEGORYirOF.\CONSTRUC.rION~>>;";', t,
o Residential I 0 Government I 0 Commercial
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Job site address: 1 C{,(J ,::-.,(, ~'- .::::.-r
Ciot;;;. 0 rl./ State: CfL/ I ZIP:
, R;mren~~: \.,,,,,):::\\12."2.. 1 Taxlot..
{"', '. ."OE:'!iCRIPTIQN UFWORK"""';>', .,,~:;,./..,
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,----,...., 'PROPEl TV. OWNER .
Na\Jle:\"';' -, ~h. ~ ? _
Address:'1% 7,D~ S.,-
City::!fSo .....JJ Jv State:[)lV I ZIP:
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 rent. OAR
479.540(1) and 479.560(1). . .
Signature:
"CONTRACTOR INSTALLATION
Business name: G .A II ~ er,; \' - C &"",...d c!Jed
Address:39S<l /-!aLidbN B- ~c:i
City: f'j)'Pi d State: 6/2 1 ZIP:q'7(/71
Phone: '_<;'L//- 7<11-2J'16 I Fax - -
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!Numher ofinspections,peritem,,(.), ,~~: Qt'y,'
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Residential, per unit, service included:
," Cost." 'Total
''''ea~'i ;,' cost '.
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 $
20 I to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
60 I 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: instaJlation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
40 I to 600 amps (2)
I $ 63.00
$ 87.00
$126.00
$(06
$
$
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)
$ 55.00 $
E-mail: _ Each additional branch circuit $ 6.00 $
CCB license no.: f?7/ if S I BCD license no.2b-2-!11 C Miscellanenus fees: service or feeder not included
Signing supervisor's license no.:? 6$<15 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: <:S c;.V' l..t Ad~ Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: ~ ~ rr. '/ /\. Signal circuit or a limited-energy panel, $ 63.00 $
alteratlon, or extensIOn (2)
1..,,1, s yOU lU
laW rcQ\.!Jre UlIitY Each additinnal inspection: (1) $58.00 $
E",\ON.Oregonb"theOregon ; Itn "p ^""~.,.~-^,, . -..,',,,..,.
1\:T1 \'I \ adolited, les are set \0 t%iGt,,J:f<31t~~:j~'ft~~~\;~ARPL;ICANTJjUSE~,'~"::,,'6:,c1t;~;;:1:iWi1175'~b,;:>;}~';~,,:
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10\\OW tlon center. 11'11'1' ugh OP;R 95c bV (A) Enter subtotal of above fees
Notll~c; 952_001-0010 t CrOol)iP5 01 tne r~\es~x. "1,.(Minimum Permit Fee $58.00) Ie 1\11:. \NO'f\\\ $ / ':;>
if\ Of"'\r\ obtaIn" te\eollOI - \. >' I(") w. . u.\ . . "'-V\Jlj.J;( r ~d\-r lO'->
n1'190. 'Iou rnaJentet. (Note: tne \'>lotihcat\cfl ~~V -r\ :,(~),E,n!,(,1i';"c;t'r~~~g'~-Ci2'~ [~]j\N\\ '_~n'W . $
"";ng the 0 gOI1 UtilitY ) ~I\v<... I. " ~n, '1"11" " 'it\) rv"
, t ')r lor t\18. re 0_332-2344. I V '. \(~W[echnology I~e (~o/~ of[A])]QN $
,1'\ tefIS I-BO -r:~\ll-lIU"'-
"en ". ~\~ r:\?l'~I:: fe~:.a~~,surChargeS (A through C): $--13.-
440-2584-) (9108/COM)
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~OREGON
www.Li.sp~ingfield.or.us
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TRAN8AC;tIO~LRECEIPT
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811-8PR2010-00165
790 . 30TH 8T
CITY OF SPRINGFIELD
225 Fifth 51
Springfield, OR 97477
541-726-3753
permilcenter@ci.springfield.or.us
RECORD NO: 811-SPR201Q-00165 DATE: 08/27/2010
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224-00000-426102 $63.00
100-00000-425605 $3,15
821-00000-215004 $7.56
TOTAL DUE: $73,71
!,';PAYMENf'iG(f!Ei: '1.''!~PAYOR~;:,CASHIE~;FMACHA~.i:rG..Q~rv11v'1,;,~~~J:.S:.~~;:..~..:::;~': ";f, 'n.;. );,'1':J' ;'AMCiuNT PAID,.c,-
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RECEIPT NO: 2010000160
l'D"E S' C"R' IriT"I'O"N" ,""""""/!T/:-,/Pf.""iJ1'0t"
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Temp services 200 amps or less
Technology fee (5% of permit total)
State of Oregon Surcharge (12% of applicable fees)
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Credit Card
090029
GMD ELECTRIC INC
$73.71
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$73.71
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