HomeMy WebLinkAboutPermit Electrical 2010-8-18
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Electrical Permit Application
225 Fifth Streett Springfield, OR 97477tPH(541)726-3753tFAX(541)726-3689
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DEpARTMENT USE ONLY
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8/ -s eDl<). 000 gz
Permit no.:
Date: '6-1 ff-IO
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
" ,,' "EOCAL:GOVERNMENT ".A~I'!ROVALCi(:,:;t ;?'F":~" ~r'!l;:"v~1tJ~~~~:-~Ji7~~~t.~ I7E_ElX,SC:R EOJ,J [jE_;%~W'it~:~\r~:_(~1k't;l~'~~!~
Zoning approval verified? DYes DNo Nb 'f' ,.:; '. . .,.() ,. : Q': . .' Cost ,[Total
;1 ,',i:/,,,',:,;-\CATEGORY;\,OF .:CONSTRUCTlONl.,\" c;., ;.": ,J., ~~ ~ ~r. ?,,,.:_,~_~p~~tl~_~! ,~~~,~.t~.T., " '\'..,;:':~,: .' _~y. _;.. ":es.", " . . cost
.,..-, Residential, per unit, service included:
D Residential I D Government I D Commercial
1,000 sq. ft. or less (4)
~~2j:OB~.SIIE(;INF:ORI\IIA:nof\lr.ANjj~[OCAf;ION~;~~.i'\;f; $134.00 $
Job site address: "2Sz. s 72 ",,,, Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City: S,,p.- c. \:,. I State: Of'L I ZIP: 97'11& Limited energy (2) $ 32.00 $
Reference: ,802 OZZ\ ITaxlol.: DYl\O{ Each manufactured home or modular $ 63.00 $
.. T~' . .... .DESCRll'tION0F~WORK'~",..,< C'.'" ,',', '.' . dwelling service or feeder (2)
t L L c'<:'Ih-~ d\' t=?~ I--I\JA c.. Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
, PROPERTY OWNER 20 I to 400 amps (2) $ 95.00 $
Name: )/,:, "~' t'JUA f-/ 40 I to 600 amps (2) $158.00 $
Address: <t~ S 72. ~<n 60 I to 1,000 amps (2) $205.00 $
City: S P 1=' [.(J T StateO"l- I ZIP: 17Zf1-# Over 1,000 amps or volts (2) $469.00 $
PhoneS'/( - nL 917 'i I Fax: - I Reconnect only (2) $ 63.00 $
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E-mail: - Temporary services or feeders: instqllation,~aii~;~Jij(fI1 relocation
This installation is being made on residential or farm property 200 amps or Jess (2) ., :"t~ ~~~ $
owned by me or a member of my immediate family. This 201 to 400..ll1ps (2) . ., \ tf.\,\~';,\ R~' ~~7.00.. $
property is not intended for sale, exchange, lease, or rent. OAR 40i't~V''Ni~'(1)~,\:;\\t.?Il'~~\l'\( ~t.~ ~~6.0'O' $
479.540(1) and 479560(1).
Signature: ov~r.qqo,.\'(lfil!1\:.V 0'i1" ~\G.I'e~re~~ices orfe6d~rs section above
':.CONTRACTOR INSTALLATION' Bra~~hl:fjA~ili~~~~ ~'i..f?a)'tJ}I..exlension per panef
Business name: /2.,.... n-'CC7k1 c. f)i3A C'. 'P cr>- a. Fe~rr,!,(branCh ~rcuits with purchase ofa service or feeder fee:
Address: P D .05~ <i' t./2 Each branch circuit $ 6.00 $
City: CA.... &r N::"2 C T State: GlL.. I ZIP: (7Lj 2.(, b. Fee for branch circuits without purchase o~ a service or feeder fee: ....
Phone:C'I/. 1,'5 4 'Il. (. I Fax: - - First branch circuit (2) I $ 55.00 $ 5
E-mail: CJI,,""Hf'.IL A 1"'( _ <;;r,:;J i-/ u'l-YJ-\l.\rL .c<<-,........ Each additional branch circuit J $ 6.00 $ (~
CCB license no.: 17 '8SI 6 T BCD license no.: c..-s3S Miscellaneous fees: service or feeder ':lot included
Signing supervisor's license no.: <' SSb-> s Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: ~:/ =f-\"I(~;t,_1 Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: S. ~ ,_ Signal circuit or a limited.energy panel, $ 63.00 $
''U'\. alteration, or extension (2)
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Each additional inspection: (1) $58.00 $
ATTENTION: Oregon law requires you.to \;lr~~:k~~l~~~~~ft:~~~~AReliiC'ANmliUSE~i1~';C::j;::it~;{)!~,~e'"~"};'t, ._'.~
follow rules adopted by the Oregon Utility (A) Enter subtotal of above fees' b (
Notification Center. Those rules are setlorth (Minimum Permit Fee $58.00) $
in OAR 952-001-0010 through OAR 952-001- (B) Enter 12% surcharge (.12 x [AD $ 77l.
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone (e) Technology Fee (5% of [AD $3or
number lor the Oregon Utility Nolllleatl TOTAL fees and surcharges (A through C): $ --,,77
Center is 1-800-332-2344). /I
440-2584-J (9/08/COM)
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CITY OF SPRINGFIELD
225 Fifth 5t
Sprlngfield,OR 97477
541-726-3753
TRANs(ACTION'RECEIPT
www.ci.springfield.or.us
permitcenter@ci.springfield,or,us
RECEIPT NO: 2010000079 RECORD NO: 811-SPR2010-00082 DATE: 08/18/2010
[DESCRIPTION:;: ',"Z'.';' /, ",;'"~-::i/~i:;'.': ';;'f,.::ltjft'.-'lc~f;;. Y~CCOUN'T~(;,O[)E;:'-.jjf;"~/AIVIO_U,I'UJ)_U_E ,'(J
Branch circuits with service or feeder each circuit .. ..- . 224-00000-426102 $6.00
Branch circuits without service or feeder - 1 5t circuit .' f '\; :. '~ : . <....~ 224-00000-426102 $55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $7.32
Technology. fee (5% of permit total) 100-00000-425605 $3.05
TOTAL DUE: $71.37
~,PAYMENT.'TYP~_; ."0P~i()R ~'~C~~HI~R.[)B6\XLs8i~;'~C.QMMJ::NIS.:.::l.f",/"',">' .;.'ir~-it."AIVIOJ.Jllll.~~J[L. ;.- ----.:.:...:..J
Credit Card RITE ELECTRIC INC $71.37
398986
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