HomeMy WebLinkAboutPermit Electrical 2010-9-21
EI~ct:icaIPermit Application
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Permit no.: ~\
Date: C\. 2. \ . \
225 Fifth Street. Springfield, OR 97477.PH(541)726-3753.FAX(541)726-3689
Tbis permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days.
Residential, per unit, service include'd:
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llk~i!0t~-a:LL;.~ .,.~~~~~ ..~h,!i,__.~_" __~____-" .iIJi~H':",_r.;;!iil}.g,y;:~_~~~~~
10Ding approval verified? !X'Yes D No ' ..
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esidentiall 0 Government I 0 Commercial
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Job site address: C=='" ~ \)t\ ".~ r. C/
City: _~i' f vr~'1 1.'....1 'J'l'~ ZIP: Gf'1't"l {
Subdivisionr J , :ti~ I Lot no.: 1'1 \ \IY
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~~~;;;,%~,#",:t"~_Po:~~'_~~~~I;';-"~w',__'~w____;~_!l'!0i~:;~~~~oi_.k';'~."
Name:.,),", \ nr ,,-......
Address: '~O ~"'11. U 1) !> \a..\4-
Ci~ ....S A- -.<<...1 State: (1.)) r ZIP: Qrfu....
Phone: - - I I Fax: - -
E-mail:
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 service or feeder (2) $
Services or feeders: instal/ation, alteration, relocation
$~\.c; :J
$
$
$
$
l
200 amps or less (2)
20 I to 400 amps (2)
40 I to 600 amps (2)
601 to 1,000 amps (2)
$ 81.00
$ 95.00
$158.00
$205.00
Over 1,000 amps or volts (2) $469.00
. ~L
Reconnect only (2) ./' .. :....j: '''f'6 ~
Temporary services or feeders: installati.o{t.I~' ~J~afion
200 amps or less (2) ciS" ''I';,~\ ~~ $
201 to 40.Q.m>~) ..~ c:,~\I.\.;-a \\\~ ~'t\J8i.oo $
401 to 6bb:'!@Ili'~~~\\ \)~~~<; I>-'Of'~ 1-;;6.00 $
Over 600\~~\q<;J~~~,t~~~\~ees or feeders section above
c;. ~\\l\F"'~.'.'l.;\..
Branch cirF~!ts.:,nel:t'{'f~tion, extension per panel
a. Fee for br3fi#h'\circuits with purchase of a s'ervice or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
Tills installatiou 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, excbange, lease, or rent. OAR
479.540(1) and 479.560(l).
Signature:
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~~~~~G."',, .'",./_' - .,._,~.."",'''_,,_~_, ,_~__,__._L:;,~ilr!:i\:l"h":2.'p~~i,;:o;,,~
Business name: / A l'S tJe,-.J'n:,_
Address: J30'J. 14-
City: fif//CIZ'f~ t..' I State: tJll.. ZIP: 9?Y!8
Pbone; s:= y 1_ -7'7I..-'1P4" I Fax: 5'11-7<1(_ -"11! ~Z-- First branch circuit (2) $ 55.00
E-mail: l.;..i.tlttlufS?-tOeRr:;.v /'8\oV1 Each additional branch circuit $ 6.00
CCB license no.; 8/'-Z 1./ I. I BCD license no.: z,D-nl-c.. Miscellaneous fees: service or feeder nol included
Signing supervisor's license no.: :J sS 1- $ Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor: ~""tV fJ. ~ i;ach~i ofll?~ighting(2)' $ 63.00
Signature of signing supervisor: '::t: _ . , DIJ I I \' - N ,~Jlll! 9:,'lj(lllo)lted-energy panel, $ 63.00 $
- .< \0 m o't~\Ql'''''8W~ir(2) ,
I ~O~6'O ~';~:'
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~. ~~ f:l 0 ~'/).\\( ~<En~{f~~ofabovefees ~~ '"
Of'l~ al. ~tIil\l~rij~\nitFee$58.00) $:?, \/I.
\' Ce ~ .
~O\\iflg, \~al \~e?1 (5~%i,'l~r 12% surcharge (.12 x [AD" $ l..\ .1',i-o
O~\ \\0 \ ,s
\~~\ 1t\\lIl''Oa Gefl\0 (C) Technology Fee (5% of [AD $ ~ .l~
~~ TOTAL'_"""~"""(AO~",.C), ,C,,,;.- '\
$
$
$
$
~~
440-2584-J (9/08/COM)
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www.ci.springfield.or.u~
TRANSACTION RECEIPT
811-SPR2010-00351
573 PACIFIC AVE'
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci,springfield.or.us
RECORD NO: 811-SPR20 1 0-00351 DATE: 09/21/2010
-i-.'i<V'f:;j#iI:'~ <~ '--i!"i~ .,. -~C~_Qt.lNJl~QQE..'".;t~~'?" ;;;;~MQlJ~T OJ!!; , !.{ I
224-00000-426102 $81.00
100-00000-425605 $4.05
821-00000-215004 $9.72
TOTAL DUE: $94.77
t; 'pAYMENT T,yPEift :;P!;\''y~QR-)i';t7CA);HIER:DBoWITSB37:J;i';C.OMMENI$,,'ii:i;;i.-;'''' Pc, '+-y:- -Ti1;p--r"AMQt.lNTPAlpt',;;., .' .,ri-j
RECEIPT NO: 2010000368
tPE~CRIPfi'9N '. ';'~e;' ,i:,'f ':,~~~?~'~;;",',~;;,
Services 200 amps or less
Technol09Y fee (5% of permit total)
State of Oregon Surcharge (12% of applicable fees)
Credit Card
45950p
Iynn moore
$94.77
$94.77