Loading...
HomeMy WebLinkAboutPermit Electrical 2010-9-8 " -"'."""'''-':.-;'' - - ". ;'. - , .'. DEP,e.RTMENTU~EONL Y II ~5;?r220/ D " 0 Penn It no.: Date: 9-? - /0 Electrical Permit Application . !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. ~ . CoSt; Total :. (ea." i C{)st '. '. . ' -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 ~~e\{')\jOB};SltE("INJ;ORIIIIATIQNrJ"'ND!;l:QCA1:ION~~~;i~,:(:\: 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\ ." ~),7f,y - ( 'h d/Jt2U- O~ t/ ^ '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.' ~.- " _. ;-c~,' ,':-;fL' ';, " -. ",,~,,_Wr: ]!~ 11i'~'O .t.-";. ~2:'~":'., \~ 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 }{ 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) J. ~:1:~~.'E~ "~~'. ~OltEGON 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 .;' :" $94.77 ;'? "f."- $94.77 ,JR-",)')':"U'..(,) . . "\'" I...~.~' , .. .'.', . '.\_~' ~~.;,..L'-: I '~Ei :-;L),.. li, j' ",1,." ...r":.J:: 'J .r (I !l . ! I,. ,_..: 1"," '..,. '......' '~k'" !:.'j\' . ~:( J ,,"'.) . . ,,~,~...'- . . """. ,"'-:-_.