HomeMy WebLinkAboutPermit Electrical 2010-9-15
225 Fifth Street+Springfield, OR 97477+PH(541)726-37S3+FAX(541)726-3689
DEPARTMENT USE ONLY
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This permit is issued uuder OAR 918-309-0000. Permits are nontransferahle. Penn its' expire if work is not started within 180
days of issuance or if work is suspended for 180 days4 .
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government mmercial
JOB SITE INFORMATION AND LOCATION
Job site address: ~~ 0 11/ ;; 6 r ,t1,z/ 0
City: -5 :}./ ~ State: O~ ZIP:
Reference: 0 T axlot.
DESCRIPTION OF WORK
I?EtM RE due TO> F/ltled. L,4Ui.
ADT JOB :283- IOs"l33 - J
PROPERTY OWNER /I'
Name: c.osr c:!12E.! c;OIUSUIT/N
Address:
City:
ZIP:
Phone:
E-mail:
This installation is being made on residential or fium property
owned by me or a member of my immediate fumily. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Business name:
ADTSecurity
Address:
2815 SW 153rd Dr
City: Beaverton ZIP: 97006
Phone: 503 - 469 - 7206 Fax: 503-469-7114
E-mail: spa t e @ a d t . com
CCB license no.: 59944 CD license no.: 26 - 209 C L E
/~ Signing supervisor's license no.: 38 9l E A
Print name of signing supervisor:
Signature of signing supervisor'
IfitWh tt t~
-p .s()!, -%'1- 7//7~~~
Vhls ~
440.2584.J (9/08/COM) ~
FEE SCHEDULE
Number of inspections per item ( ) Qty. Cos1 Total
ea. cost
Residential, per unit, service includ~d: .
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq_ n. or portion $ 25.00 $
thereof
Limitcd.energy (2) $ 32.00 $
Each manufactured homc or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration. relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
60 I to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services: or feeders: installation, a/teratio,?, relocation
200 amps or less (2) $ 63.00 $
20 I to 400 amps (2) $ 87.00 $
40 I to 600 amps (2) $126.00 $
Ovcr 600 amps or 1,000 volts., see services or feeders section above
Branch circuits: new, alteration, extension per panel
a Fee tor branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
~iscellancous fees: service or feeder not included
Each pump Or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, J $ 63.00 $
alteration, or extension (2)
Each additional inspection: (J) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ 63.00
(Minimum Permit Fcc $58.00)
(B) Enler 12% surcharge (.'2 x [A]) $ 7.56
(C) Technology Fee (5% of[AJ) $ 3.15
TOT AI.. fees and snrcharges (A through C): $ 73.71
SPi~N...~~
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..vs:i0>' OREGON
WWW.ci.springfield.or.us
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TRANSAcrib'KJ RECEIPT
811-SPR201Q-00306
4660 MAl N ST
CITY OF SPRINGFIELD
225 Fifth 81
Springfield, OR 97477
541-726-3753
permitcenter@cLspringfield.or.us
RECEIPT NO: 2010000327 RECORD NO: 81 I-SPR20IO-00306 DATE: 09/15/2010
IbESeRIF'tloN~' :",~'<-;,,';.' ." '~,- ",,;.,~~;-t-~:~\f'!, -,,;,,;;:j ll"~i;;_e_o,lJli:r:iG.QRE:'- 'f~'\i"\';;;AMQ.DNT'DUE- '.:;,,' '
Signal circuit(s) or limited-energy panel, alteration, or extension 224-00000-426102 $63.00
Technology fee (5% of permit total) 100-00000-425605 $3.15
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $7.56
TOTAL DUE: $73.71
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Check
ADT SECURITY SERVICES
INC
$73.71
$73.71
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