HomeMy WebLinkAboutPermit Electrical 2010-9-8
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Date: 9-? - /0
Electrical Permit Application
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!55
225 Fifth Street. Springfield, OR 97477.PH(541)726-3753+ FAX(541)726'3689
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.
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'. . ' -5li!0C~Li:GOVERNMENT::AP,PROVAlfr"",,;;oj;!fjff;;r.:j
Zoning approval verified? DYes D No
:'F. ':',(;,;,;'_,~':;~C,6.TEGORY;;Of,;;C0N$TRUCTIONr:;Vj j "A" ""c...
D Residential I D Government I D Commercial
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Job site address: '7 () ~ (I Onr or'a-..f -# )
City: FIJI},.) 1'1J I State:(')y~ ZIP:
Referehce:J \' 1D';::'.j+ A":'J Taxlot.{J\)t.,f{5
'/ 'J' DESCRIPTION:'QF'WORK.'" ;,j\: ,.. ,"'i\ ."
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^ 'PROp,ERTY OWNER "
Name I )tJ\vICl d;W\M'-,f
Address: --7 ')J) S' F ',S1 t~
City:,~ h'::4J /1-011 l State: A
I Fax:
- 'Ieo;" " - '.~
,Number'Of,inspeciions per it_in 0 : ; Qiy.'
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Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft, or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
$ ,f/
$
$
$
$
$
/
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 IJITlpS (2)
60 I to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
$ 81.00
$ 95.00
$158.00
$205.00
$469.00
$ 63.00
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ZIP:VfRt::;'1-,l.[
,
Phone:
E-mail:
Temporary services or feeders: installation, alteration, relocation
200 IJITlpS or less (2)
$ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services Or feeders section above
This installation 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, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
.' . ..CON:m CTOR: INSTALI.AT10N~. . ~
Business name: r 1 J r r'l J/ r (()J
Address: [, ()' nt Y- JJC?r
City: \~P ~ If i Y V I " /.fJ I State: I ") rf ZIP:Vf7 J../.. 75 V.
Phone: - - I Fax: - - First branch circuit (2) $ 55.00
E-mail: Each additional branch circuit $ 6.00
CCB license no.:! ~ fo '-Il.-f {fJ I BCD license no.: Miscellaneous fees: service or feeder ':lot included
Signing supervis~r's license no.\ L/--;)..I S Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor:\ I~ i J Each sign or outline lighting (2) $ 63.00
Signature ofsignmg supervi {' \ I \ ~l~ ~ )~I'\I..l\TI\l\ Stgnal ClrCUlt or a Iimtted-energy panel, $ 63.00 $
l~r: ~ J" u ,l\l\l\H alteratIon, or extensIOn (2)
.~ '-' '-" V' 'l Each additional inspection: (1) $58.00 $
t\c-I (C) Technology Fee (5% of[A]) $ ~ . n' :>
'C TOTAL rees and surcharges (A through C): $ 9-<-1. 77
Branch circuits: ne~ alteration. extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee;
Each branch circuit
$ 6.00
$
b. Fee for branch circuits without purchase of a service or feeder fee:
$
$
$
$
440-2584-J (9!08/COM)
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SpR20.10~00255
'. ~ ;.i, ~ \.. 1\;
1703 COt;J,9,o~PA VE APT 1
CITY OF SPRINGFIELD
225 Fifth 8t
. Springfield,OR 97477
541-726-3753
permitcenler@ci.springfield,or.us
RECEIPT NO: 20 I 0000253
RECORD NO: 811-SPR2010-00255
DATE: 09/08/2010
tQ!;.SCRI P,lION :{;.x:'r<;:;r"f7~P/~,E~; 'e "'~+':1:JFf:,~./ ":.:\~'-7X"::iiJl.itcQi.iN;ii..cJ)OE ..:iii-'~fC,jti';; ';AM:<:tQ.N;ij:ilJ.~i'':.:- .:i'.' ,. -1
Services 200 amps or less 224-00000-426102 $81.00
Technology fee (5% of permit total) 100-00000-425605 $4.05
Slate of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $9.72
TOTAL DUE: $94.77
Uf'&!'il!::!!:rJyeg'- - d"PA:C6.B'~'/G~sI-!!.ER:BRICRAROSO-_','t9MM~i{ts-{i{;:{:,~ H':!1_', AM_OJ,JNJ~~AID - ",'" ,j
Credil Card
015120
BURREll BROS
ENTERPRISES lNC
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$94.77
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$94.77
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