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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 ~/J~pVl.o/O -0 'I I Date 3!JQ/2o/0 I / 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 Vt2.AA)~ /7.CX1~ ri/IO do -yw _ '\:!lJJ...rYI,O/R. # 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') / /\, 7./~ / 'V~ \~\\){) \Y~ ~: CX\ \j' 440.2584.J (9/08/COM) SPRINGFIELD -.:.rr,~~.,-'I.. if; , '.'J ~. -.4.1k.'8J",:,,,:~)1 [~:~~:~, &J 'i~<_:: 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; cKl S .-\~ '1 , ",P sr.~:r.I~~ ~~, ~'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 " ~ ,'. '. 1 . ',.- ,,'~+"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 j ~{ ,~,:'~;,,': . , 'j 'l " .;l I't:' . -- ,. ',"" 'J'.:,3i.j,',;Hi\:.ki--Lll,",)I" ,';:.;J2,t ~L;"~)"~;- ,j;f..!, ..\' >-<.".~ ..--.. '. ." " I ~!. '... i'1 , . " ,;' :1' ; ~I~: .. ,:" ~..,- .~,,' ?r;~' '::ir;\~s\; " f~:': ) , " ~- ,'1