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HomeMy WebLinkAboutPermit Electrical 2010-8-31 '- Electrical Permit Application -- 225 Fifth Street.Spdngfield, OR 97477+PH(541)726-375HFAX(541)726-3689 '" -,'. DEPARTMENT USE ONLY ..>''i,:' . .' -.--. SPttIO-OO I gcr Permit no.: Date: .8. 3./-/D 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, . " " '<1:20CAL;:GOVERNMENT;AFWROVA!,:":,,,';f.t:eiii~','f Zoning approval verified? [J Yes D No i;i,"CATEGORY,~Y0f,;'C0NSTRUC::TION\~i> . o Residential 0 Government ~mercial ~~~fi~aOB.fisl;r:Ei'~INl'bRMATIONi:AN[j1Jt:;()CA'rION:~ti!2fj .3 'Sh~II(..'-1 ST City: ~ State: Otl... ZIP: G11-1 7 Taxlot. DESCRIPTION OF'WORK' 12 ',iI./ i ,Vt-.u I. f . PROPERTY . OWNER . Name: ,w..t,'c..- Z>~_i'-D..t..- Address: 'te 7 S-I j)/.:..,,; <- (Ld/J City: l.'~" o. L- ZIP: 'i1-{c'J, Pho .d: '",(1 '7?v 0 Fax: \E= This installation is being made on residential or farm property owned by me or a member of my immediate fam' ,This property is not intended for sale, exchange, Ie or rent. OAR 479.540(1) and 47 0(1). Signature: LLATION' Business name: flD~ v.( Address: Print name of signing supervisor: Signature of signing supervisor: '~~Y'~-:~J~~~~~W~:I~~1,f7,+\--FEE~SCHEDOUiE:.1t~Jt,~~~!4rif;~~~~~F1 .., L"d' _ _. '_ ._ ,,'_ .', ,,'- .,.. _ . ""- . ,", ._. .,. _ ,~- '. . _'.. ...:.;'.;" . ),~ u ~.~e,r' 9l'.i~_~p~~tl~~'~~ ':~~r j;~.~: (,)':<.;~:IQ~Y'.' " Cost ;, . Total' '..,~.'. .' ~ _". '"'" .'-, __ ~.i,..,r.,.. ,\'1, "',;,' ,;. "",'..>1, _",'" ,,\'-',_~~iV: '. :. c_ost i. 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 $ 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) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension per paner 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) t $ 55.00 $5'> Each additional branch circuit 2-" $ 6.00 $I'L~ Miscellaneous fees: service or feeder ':lot 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 $ ~~tgil~~~~~~l~Jt-~f~fARP-jJiC_,a:Nm~JJSEt}~~;:':'~'i[;qj~Qf;1~t:~1ai;:?,-,~~.,,: (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) $ l7 S- &iii Enter 12% surcharge (.12 ~lAir .. $ zi f(Thfilt{ 5V,t;,tr~j)~t,~v~~~ $ L'IS' imll~ .~g'~{\l.e~(~J:~f~~g~ C): $ '211'1 :"If'' ~IVvCU un I MLJMI\lIJVI ~ \t<\ \ ~ \J.' .~. " .'1) ATTENTION: Oregon law requires you '.0 '" follow ruhis adopted by '.he Oregon Utility @' Notification Center. Those rules are se'. for'.h NOTIG in OAR 952-001-0010 '.hrough OAR 952-001- THIS P 0090. You may obtain copies of'.he rules by AUTHO calling the center. (Note: the telephone number for the Oregon Utility Notification COMM Center is 1-800-332-2344). ANY 180 DAY PERIOD. 440-2584-J (9/08/COM) .. - . ~ it't . j. www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2010-00189 632 SHELLEY ST CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541~726.3753 pennitcenter@ci.springfield.or.us RECEIPT NO: 20 I 0000 192 RECORD NO: 811-SPR2010-00189 DATE: 08/31/2010 lQs~g~PT[9tf'~~!;{i;,'~,;;,,~;~;g;1r~~';'t';"/~~llift:l.fi:j~4c::.c.O_UN;f~CJj[)E0l;;.;~::;JJ;"i':!>AMQUN;Tj:jj.l.~;:JI:";i;j'.~' '. J Branch circuits with service or feeder each circuit . . " 1.~, ~:''' ~ 224-00000A26102 $120.00 Branch circuits without service or feeder - 1st circuit ... ,"', t. i. 224-00000-426102 $55.00 ..~. 821-00000-215004 $21.00 100-00000-425605 $8.75 TOTAL DUE: $204.75 1"'PAYMENt fYPE~Y;';'PAY0R;~?CAsHTER"DBoWCSBY0i.~',cdnirMENtS:!ii''ifflJiiJiii..fl.i/':' /-:~AM6uNT PAlOI';j[,:'Ii>.'Y"" I _" ..' _ I" .". __.'.. .., ,. '...!':H'''''' .... ...."... .., .... ..'_'~" 'w...~...'H' ,..,...~._._~ _.,'.. ". .~,..~.......".. . State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permillotal) Credit Card 093131 . mason menge $204.75 $204.75 (" ~ . '. ,", ,J~,}.i': ..: "~I ; "..; " ; ;.~:<, :; . ". ~, " ", l~' ,'.," ~ ! , r