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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,.,. ,., -~ ." "' . ~. . ~. 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