HomeMy WebLinkAboutPermit Electrical 2010-8-18
.
Electrical Permit Application
. .
225 Fifth Street+Spdngfield, OR 97477+PH(541)726-3753+ FAX(541)726-3689
SPRINGFIELD
, ,"
'.
. DEPARTMENT USE ONLY
',-,."";, . .
selL 'U>lu - 000 "6'0
Penn it no.:
Date: c;..:./tf -/0
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.
','. ,'.' -t[()C.&.L:GOVERNMENT'AP,F!R()VAL:!1~,""\1'ii;";i'"
Zoning approval verified? 0 Yes 0 No
:i, ',:f,:'\.,'),0CATEGORV:ji(jF-:CONSTR.UCTION~.i\".
o Residential 0 Government 0 Commercial.
~J<'i!i'&:S'dJ)E3}1[Sr"E1.INF.ORNi.&.l'ION;:AN[j~LOCA'liIONw~~i1S(i,,:;'i:
f.P Cf.
City: S te: ZIPq 8"
7{)'L ~ 14 z:. Taxlot: 07 ?(]
'DESCRIPTION OF WORK":'"
i--...-;t vi (I::: c:::.h:""r'-
Name:
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: tV, II ,
;,CONTRAClOR
~ IL
'637
City: ~!.-
LJ]
E-mail:
CCB license no.: 3 y' ( 5" /
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
:!f~~?j;::;~'t;;'rt3.~~i;4:!-y!j~1~~.~!:{if{:;N,:i FEEt4sC H EJj.013E:~~~"f<\i;~t0X~lWl~~~~~~~~
..... ", " . ',' -, .. Cost, . Total"
jNumber ofinspectio'nsper item.(,). .'_, 8tr ;:',ea.-': . . cost
"', .'~'~" . ',;"'-.' ~... _,_: .,...:'~.' .'-~,,. ",1,0; _'.::::'/. '.
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 ~ervice or feeder.,(2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) K $ 81.00 $
201 to 400 amps (2) \ $ 95.00 $
401 to 600 amps (2) ! $158.00 $
601 to. I ,000 amps (2) ,
$205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
, Temporary services or feeders: instq.llation, alteration, relocation
20q amps or less (2) $ 63.00 $
to 400 amps (2) .
201 $ 87.00 $
. ~~1.;i'600 amps (2) $126.00 $
.Q~?~J~ or 1,000 volts, see se;';icd{6tf2~d~rs sectIOn above
""ur ~ ; ,II;~'
B,r,a,nc~ c r U:, n, .lre . i r ~.... ';.. ,
I ;~:.F.~~~tot ~ta\jt ) c 1~' i c./. iC~ tlr feeder fee
:111/111 I.' . ....<<i.
, Af\E,achl~'l'~~h,~rmt\:llnn 'un y:,; r:;.s','oO I $ .
b. Fee for branch circuits without purchase ora'service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder ,!ot 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: (I) $58.00 $
;~;';i4.tttt~~~lff~i\*~~1~~ARet]lc~NF~:US_-E~~i,t:i:~2h;~;'f,~ili5~~i:i/;;,t_~~:..: .~
(A) Ent~r'subtotal of,a1:Jove fees $ 8' 1
(Minimu'm Permit'Fee $58.00)
(B) Enter 12% surcharge (.12 x [A]) $ 97~
(C) Technology Fee (5% of [A]) $ 'f()~
TOTAL fees and surcharges (A through C): $Cftf2L
ATTENTION: Oregon law requires you to "
foll.ow r~les adopted by the Oregon Utility
Notification Center. Those rules are set forth' I".
In OAR 952-001-0010 through OAR 952-001-
0090.. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notificatio~~
Center is 1-800-332-2344). \Jl"t.),~:
440.2584.J (9/08/COM) ~ ~
.-
. ........
..........').'
':, ,".-. '
~....<.....-, - U10"-' I',~. ~
~-.;.,.. ',<
,
'......,-.. .
'1,\'~ -:::
/:/
,
~. '{Y~ \.. <~j
",: \.\ \ <'.
_~.~ I o':~
t" {\..--
-' "\.
"'\t"':"
"1 .",....
. , . '
,
o
r~/
I r '/
I
-
.-4
\.
,
--\
I
I
I
I
I
I
(',
\',
-. ,
~".,,;nn. :~:.... .. - .-",
;. 1<':';':Ht":"-:~: p~
. _": ''1\ t'n1:
,'. ';;'~:;~E~:,;kr;j;
. i,j 'P/ "r' :~.,' .J I'
...".....
,
-'
- ,
'.':.
~. ,~
-) \~)
- \
~.
ii
,
-,
('i-, !' (),.
. ,;,r. ;....!. .'l''':I{''
,,1.(,. 'J '. I
A.....; 0""'''' . ""
I <;,' ~/'') ~ ;:/
'"t / '~_. .,'i' . 1./
, . i
.\
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
. .;~, ~~-,: ,"'. -
\\~)t~}'b' :Jt~r\,'fn~,-:'}!l' '>~' j.
permilce nter@ci.springfield.or.us
RECEIPT NO: 20 I 0000077
RECORD l'!,9;')~,i;!.-Srf~,21 ?~00080
-. ....;.:i*~:o..s~;,..;\:.;.~..-,:...../o.<.,.:.:"...y,. ',. ^."', ....-. .--. -. ."'.....%;:.'>_::_r:..::"'..""..:_.~.:..
.. .... . ;..~+~iiV,cIF'Si.$ ,"ACC.o.UNT~C.ClDE.::;&~t<lifi' ',AM09N.U!UE
224-00000.426102 $81.00
100.00000-425605 $4.05
821-00000-215004 $972
TOTAL DUE: $94.77
Jf+?:;ft::..i.J~ f'8M.O.I.J~UEAIIL_'
$94.77
DATE: 08/18/2010
t!lESCRIPTIOtlftTf""-:::~~"~, ."",,:
Services 200 amps or less
Technology fee (5% of permit total)
State of Oregon Surcharg~ (12% of applicable fees)
1
P:~PA VMI;NT l'YPEf"';"=j5AY:OR ,;' . CASHlE~,:OBOjNLsBY,i ~t'C.ClMMENl:S_":"_1 - '.
Check RUSSELL ROBERT S
5415
.,i,.,. ,.,
-~
." "'
. ~. .
~. I ;,: ~,
~.:ifJl~~ ~r~~.:!if!:;:;,:" ':
. ", -,...~'.;;.,.~::.~.:.
?i7ti',,-, .
',~MdUtI . \'~~.({J~f,; ,:
'~f':C
.~,J(:r . ~ ,~
,~~1 ~~~~~/~;"
',. .