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HomeMy WebLinkAboutPermit Electrical 2010-9-17 .\ \, .E~ectrical Permit Application J . . . CITY OF SPRINGFIELD, OREGON . . , I .' . , 225 Fifth Strctt+Springfield, OR 97477+PH(541)726-3753+FAX(S41)726-3689 ~~ ;t?:h\1i;'rr.it.:'"q~.l'S -"~)Jil;'$~4t1"t:;;:;'::;;,;2Ti jil.....".. r':'i'1f!0~j't. ''Ii:'' DERAR'TMENiI USE'.ONILy"...".j, S;\!K"+'ff0:;ffiV&!) e),~'{;7?l'if1!'1.3g'+j S,' , '}'''t'il1-j,'i<<~~1m Date: , Permit no . 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. Signature: ~:;,~~V:l(~~I<::Qf.liJfRA€i!tQR,lijf.l"S;rM[!A;]I!!)tiI.i!:I~'l!~iKf~~ Business name: /)YV"\ I J rf n/1 /){. ~ A 11 .n 1111 A Address: I~l ~. 0""1i'^- -r~,. , t City:~no.t;-orrfl State: nQ ZIP:Q7l/1 Phone:AJf -1U1-f ilC::;/ Fax: sJ (. -/0 1-TJ2.L'" First branch circuit (2) $ 55.00 E-mail:-hnLJ..t.;r.(}I(\rla....j1.VlVln.I(.~(..Vi. E~ch additional branch circuit $ 6.00 CCB license no.:( o;:::J.J~D BCD license no.: I Miscellaneous fees: service or feeder flot included Signing supervisor's license no.: 4L(rJ~1 t:fl Each pump or irrigation circle (2) $ 63.00 Print name of signing supervisor:~8 I 'e'.- c:rn fI (o01.!; oBa;;)1. sign or outline lighting (2) $ 63.00 Signature of signilig supervisor: k.... _11.. ?tJ..."'" - ^" fJ. - Signal circuit or a limited-energy panel, \ $ 63.00 alteration, or extension (2) l ~;j:r~tilE~c~IbW&G'c)YERNMI;N;t~~4e!:ll{9S~~I!. Zoning approval verified? 0 Yes 0 No ;g;,~~'1i"''!!MG''M)E~QRi(j,ofi;11c,;Q~$T!RLt0iiiIQN.;- o Residential I 0 Government . I rslCommercial ..~"JO~~!sIIifE~IN"gFfM:A=tIGlN~~NP~EGlC~'iJ19NIr~i&i; Job site address:( n~ '7-it\ I \ 1J' " --;; T' r' ~ t- City:~J\...Jr;f\O ~I-t 111 State: 1\ d.' ZIP:q,\.f Subdivision: \If:I~'2.''t~ Lot no.: Oo.5C !ll~~~~~;ijtiE:{li\RI~f;jQr-.l~i;5El!Wf:):!iKi!~i8~ . -C,-,-T2d ;\ ~O (I.Y\V I t' V r~~~~~~ek~~~~~y~~l~ Name: \ [\1 r"'t.r :\~ -.D . It' \ I,,, I~ In, J 6ilJ' 1( ~ State: tJlL ZIP:c..t14{Y/ - -' I Fax: 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). ~.~~c,s ~ t>-;{;) ~\~\ ~~ '*' ~ 440-2584-) (9I08/COM) " ~~'..1~F"J;g~lSQ~-E;bJil!~;~~~J;Wlt:~t"~:!rpt~:~i:~~l 1i~~~J Qt~ .(;.i>~~~ 1):0:!3!' ~:~~:..rt~~ ~'r'!~P-lIlfi~~;jf;,<<, ~~O~Wl!~ 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 senices or feeders: installation, alteration, relocation 200 amps or less (2) 20 I to 400 amps (2) 40 I 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 I $ b. Fee for branch circuits without purchase ofa service or feeder fee: $ $ $ $ $l.J3 ~O Each additional inspection: (l) 'm:lTG~N:i\rUSE-. ~ml,!.~." '. ... (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) ,- , (B) Enter 12% surcharge (.12 x [AJ) (C) Technology Fee,(5% ?f [A J) TOTAL fees and'su"~harges (A through C): $58.00 $ 'oS' .~ $lJ.3.CJb n.~., $'8.\, J $:~'=5:i \ ! " 7/ ~ ....:. WNW.ci.springfierd.or.us TRANSACTION RECEIPT 811-SPR2010-00326 632 SHELLEY ST CIlY OF SPRINGFIELD 225 Fifth $t Springfield, OR 974n 541-726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2010000347 RECORD NO: 811-SPRlOIO-00326 DATE: 09/1712010 224-00000-426102 $63.00 100-00000-425605 $3.15 821-00000-215004 $7.56 TOTAL DUE: $73.71 ~ITRfRAYME'N1i~E.hiflTI1jjEAYOR~~~fM.~8JE~Il~~H6~e[R&:~ikti(illco'riijEN1tS!h~.1&_ffit%1lmRL)1U)mih7r~~Ef~2fAM6UNTipAID~~i~~m~;;m~iY;;!~hi Si9nal circuit(s) or limited-energy panel, alteration, or extension Technology fee (5% of penmit total) State of Oregon Surcharge (12% of applicable fees) Check 40575 OMLlD & SWINNEY FIRE PROTECTION & SECURITY 157 South 47th Street Springfield, Oregon 97478 $73.71 $73.71 , ,