HomeMy WebLinkAboutPermit Electrical 2010-8-19
Electrical Permit Application
225 Fifth Street+Springfield, OR 97477+PH(541)726-3753t FA.X(541)726-3689
DEPARTMENT US~ ONLY
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I Date 3!JQ/2o/0 I
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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.
I LOCAL GOVERNMENT APPROVAL I
Zoning approval verified" 0 Yes 0 No I
CATEGORY OF .CONSTRUCTION
o Residential I 0 Government I 0 Commercial
'.il{.,..:JOB SITE INFORMATION ANI)" LOCATION
Job site address/ I~I d! U ::57
City: ' I State: I ZIP:
Reference 't1rYZ~~ \ I TaxlotcO 2.~'
""' 'DESCRIPTION OF WORK
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PROPER-A' OWNER
Name: CP~~
Address: / '" ./ 7 C. y
City: ~2/ I State ~ I ZIP: 97'70
Fax:
Phone:
E-mail:
This installation is being made on residential or farm properry
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Business name: /{PI' ( IJ ~/, '.A r:{"".. h'i<> //(1
Address: 4'G~ ~.lTl1.f'A AM~Lh f)):
City hA.a~V'-"" I State oiL I ZIP:97iIO(
Phone: r!/t-'JI14,f1..f il Fax '>lt1-7trt.L,j<((It;'
E-mail: /frtlJ II ^lA.~ t-A:" HL. \.~) a ,,/ ~ (1,.,.-..
CCB license no.: i'Z,(?C)t;;(' BCD license no.: .-"7~ I./O;;?'t'
Signing supervisor's license no.: tlJt.((}) A
Print name of signing supervisor: (~t-t.tt.vl/~/!/t;-"",c,
Signature of signing supervisor: I/L A, A') / /\,
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440.2584.J (9/08/COM)
SPRINGFIELD -.:.rr,~~.,-'I..
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FEE SCHEDULE'
Number of inspections per item () Qty.
'.. .
..
Cost
ea.
$134.00
$ 25.00
S 32.00
$ 63.00 I
Total
cost
I
$ -/r~V
$001
$
$
Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq ft. or portion
thereof
/
121
I
Limited energy (2)
Each manufactured home or modular .
d\\'elling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) S 81.00 I $
20 I 10 400 amps (2) $ 95.00 S 1
401 10 600 amps (2) I $158.00 I S
60110 1,000 amps (2) I 5205.00 I S
Over 1,000 amps 0' volts (2) I $469.00 I S
Recannecl only (2) I S 63.00 I S
Temporary services or feeders: instaliation, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
401 to 600 amps (2)
1
I
$ 63.00 S
$ 87.00 I $
$126.00 -I S
Over 600 amps or l,OOO volls, see services or feeders section a~ove
Branch circuits: new, alteratiorl, extension per panel
a. Ft:e for branch circuits with purchase of a service or feeder fee:
Each branch circuit
I $' 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
I S 5500 I S
I S 6.00 I $
Miscellaneous fees: service or feeder not inciuded
Each pump or irrigation cir~le (2)
Each sign or outline lighling (2)
Signal circuit or a limited~energy panel.
alteration, or extension (2)
Each additional inspection: (l) II
..r.;v~ .":,; ,:. APPLICANT USE
S 63.00 I $
$ 63.00 $
S 63.00 I S
$58.00 I $
~(A) Enter subtotal of above fees
(Minimum Permit Fee S58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through C):
I
I
I $ ~ ~
T ---;::vr~.C; D
$ I gL;
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S
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~'OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541.726.3753
WNW.ci.springfield.or,us
permitcenter@cLspringfield,or,us
L~I;SCRI8TION" ' +...;V' . .:\ ':!C,/,
Residence wiring 1,000 sq. ft. or less
Each added 500 sq. ft. or portion
State of Oregon Surcharge (12% of applicable feest
Technology fee (5% of permit total)
RECORD NO:8]:I-S~;!l-~01O:00089 DATE: 08/19/2010
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. ',.- ,,'~+"Vt;i:.J'\",;::; 'ACC'OUNT CO"DiE" '> ..'~: .it A' M"O UNT DUE'" oJ
t2.~,p.~..~~.,...~,--"'.,' ,>, -..... '." .~~""'-"'i"'.;.. ..'" .,...~.._ . _____~__.......__...1__-'J
':.r;;:.~~' ',' ..... f 224-00000-426102 $134.00
----,
224-00000-426102 $50.00
821-00000-215004 $22.08
100-00000-425605 $9.20
TOTAL DUE: $215.28
;::(:5;.Y+~~AI\I10liNT.pAID .
$215.28
;":.
RECEIPT NO: 2010000082
[;,PA YMENT'n:!iE'" ,;r;YVf>A Y6R.''.'';.~i C",SHIER;NMAtHAQ9lV!:~<;;;~ri!JM~N:tS
Check BEAR MOUNTAIN ELECTRIC'
05168Z LLC
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