HomeMy WebLinkAboutPermit Electrical 2010-8-12
This permit is issued under OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started within 180
days ofissuauce or if work is suspended for 180 days.-
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Zoning approval verified? 0 Yes 0 No..
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o Residential 0 Government To Commercial
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Job sile add~s; ~.() (p Lt "J.. y;rn 01.
City;-:' O,I-ri I State,nff ZlpvT fLf7/
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Address: ~O ~ C:Sv b 5 ~
citylJAth......vr!{c I State: ~ ZIP:97#(~ (
Phone: - - Fax: - -
E-mail: ATTENT'If'lhJ. Temporary services or feeders: installation. alteration, relocation.-
This installation is being made on residentil:l. ,',.. t!Il,P!\!PStit,';H911 ~P"~3s .or less (2) 7 $ 63_00 $ ( n r, ./
owned by me or a member of my Immedla!eCfawIyt.Jiffll" ,t, pea b) iilH tOl409 ao'\?su(~: $ 8700 $
property is not intended for sale, exchangel,lldilS\f,/<[tf2!\j['nM(. TI 0, ;'.' 1" '~:" .
479.540(1) and 479.560(1). 0090. Yo~ - D'(:OOlO t f( ~;0r~~qO!amRsf~t:h $126.00 $
Signature' calling thema~ _~btain ;0 ).ov~;;606'ari.'i2 JKl1GOO volts, see services or feeders section above
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~:~~::rCw0NT~i[J.jR!INS5r~~lfA~~@!~r~~T -. '-' _ Jor !:!~~it,~hl~~~~~&rClM~, alteratIOn, extensIOn per panel
Business nllme: IAI I Y r '-Ii I J r )"(U~r IS 1-80, _3t0':J.;~I!~'.bransl1,~ircuits with purchase ofaservice or feeder fee:
Address: (.) () ); 'I.. in V)...... Each'branch circuit I $ 6.00 $
City: WIA l/<f 'Iv; If State f) r{l ZIPf-f 'ill ')5(,
Phone: /}. l.j '7 ~,/Y:7- l Fax: ~"7. '-I L/ /I)t} / . First branch circuit(2) $ 55.00 $
E-mail: ...hirYif)VI.DS/~..vl}...)/AI1Y7hnf./~)..1Y7 Each additional branch circuit $ 6.00 $
CCB license no.: J ~ Iii ( III (r,\ BCD license'~ 0,: . . Miscellaneous fees: service or feeder not included
Signing sup~rvis~r'S'li~en~e'no: :-q=- :11 <./i.. Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor ~ vIr) r )v r r110il Each sign or outline lighting (2) $ 63.00 $
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I\t., '" . ..-- - (A) Enter subtotal of above fees
V~l\t>.~' ~\J NOTICE: !"('j" p'. -! '(l~iiIii;num Permit Fee $58.00) $ -6'>
'v THIS PERMIT SH~~ ~Xp"IRE :IF:.!t6tt1~Vo surcharge (.12 x [AD $ 7 )b
AUTHORIZED UNDER-THIS PERI no ogy Fee (5% of[A]) $ 31 J
COMMENCED OR IS ABANDON
~ ANY 180 DAY PERIOD. L fees and surcharges (A through C): $ "/771
~lectrical Permit Application
225 F;[Ib Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
440-2584-J (9/08/COM)
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Permit no..:
Date: 8-( Z. -/0
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" um erO ,IDS ec Ions, cr"rem;,"ffi. .. ~~,t""'"_ '$_~ V~.,__.,__ -~";
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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 $
dweiling service ?r feeder (2)
Services or feeders: installation, alteration. relocation
200 amps or less (2)
$ 81.00
$ 95.00
$158.00
$205_00
$469.00
$ 63.00
$
$
$
$
$
$
20 I to 400 amps (2)
401 to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
b, 'Fee-for branch circuits without purchase of a service or feeder fee:
S7~:.IEL~
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~OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.c\.springfield.OT.US
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000042
RECORD NO: COM200'9-00806
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DATE: 08/12/2010
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$1.341.70
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$2.180.26
224-00000-426102 $63.00
100-00000-425605 $3.15
821-00000-215004 $7.56
TOTAL DUE: $3,595.67
,- ~"- ,,;,.:,; - AMOUNT PAID. ., . . ,'. i
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$73.71
lli~SCBIPTj6NY . :-:-:';'. J";-;-' . p'
Plan Review Fire & Life SafetL_,,_
Plan Review Comm/lnd/Public
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 BURRELL JOSHUA J temp power only
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