HomeMy WebLinkAboutPermit Electrical 2010-9-8
Electrical Permit Application
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CITY OR SPRINGEIBUD ~ORE(jON"'3
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
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'. DEPARTMENT USE ONLY
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Date:
9- cf-- /0
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.
A . 'PROPERTY 0 IVNER '.. _' . 201 to 400 amps (2)
<' J /,1'"\ \.i l' J)f1,1]'Ml ~ A01 to 600 amps (2)
Address: In -flf:..ijj\-fI- ~. - 7Jit1'..,:0 601 to 1,000 amps (2)
~"T,~,iI .'" '.". ",." n' , ' I' J..J.'C ''1~ 1" Over ],000 amps or volts (2)
City: -' ~1~":'!M;;~tc'YA I~tate:t JJ~"':':i~I,2;IP,:;t:\nr
Phone: _ Iii OAR 952-001-0chliax.:rough OAR 952-001- Reconnect only (2)
E-mail- 0090. You may omaln COjJias Ul lilt::: 1 UI~::; uy Temporary services or feeders: installation, alteration, relocation
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This instal1atiO'l1\:ir1'lfjgmuP~. ~1!;~<e>~i!~!'tia,\19lyff'rmill(ll1l1m1Y
owned by me or a mem ~ !'1i>SI'Am~e!~te2~ibl-\ ThiS
property is not intended I ~ Ie, ex'cnange,'iease, otTent. OAR
479.540(1) and 479.560(1).
;';0, .;, :"EOCAL:.GOVERNMENT:t,iRI"ROVAlf;;>~::f\~f~";7:'
Zoning approval verified? 0 Yes 0 No
"c >,,:e",:' -'''::;'CA'T'.'E GO Rv;rO"'"C O"N sTR'U'C. ....f"N.\.''''',..,. .',,-'
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D Residential I D Government I~ Commercial
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Job site address: /4.",- mnhaM.)k
CilJk.~.DAI'- A~/J State: OR I ZlPe; "1-1
Refer'-:ce: :--t7n.,~~34:: Taxlot.:Oi \D r'
.." - :', ,: .': :'DESCRIPTION;_';0F~'.WORK;J'Ii.~,iJ~~;J'~:~~J;k~~,::~~~:
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Name:
Signature:
'. ",:CONTRACTOR INSTAllATION
Business name: -fIr' {rNI/t/Y"I~"(' A ( S
Address: p,(), ~f)J 7(1'7
City.. <:OAVltrlhl:J1 State:ox.... I ZIP: C}1f1 Z
PhoneW / -'1;:fQ-:JInrv r Fax<:LI/ (Jq / dJ/7
E-mail:~~..I..~-t+r.^.WJ./T1;;
CCB license no.://oC.I / I <t BCD license no.:
Signing supervisor's license no.:OlO-~ CL€ ~
Print name of signing supervisor: ~7 ol"f ~; /.1) CK:> d
Signature of signing supervisor: / \-,J :- U l~
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iHIS PEliMiT SHALL EXPIRE IF THE WORK
.IJTHORIZED UNDER THIS PERMIT IS NOT
l JlJlIVIENCED OR is ABANDONED FOR ~
AiN 130 DAY PERiOD. ~~f(r.b..' ..
440-2584-) (9/08/COM) . i>'~
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.' __. ,..:, '. '-'.:,. ,.' '.:'H,,'''i;'' " Cost: '. Total
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Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited energy (2) I $ 32.00 $ ~, ..
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or Jess (2)
$ 81.00 $
$ 95.00 $
$158.00 $
$205.00 $
$469.00 $
$ 63.00 $
200 amps or less (2)
$ 63.00
$ 87.00
$
$
$
20 I to 400 amps (2)
401 to 600 amps (2)
$126.00
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration. extension per panel
a. Fee for branch circuits with purchase of a se'rvice or feeder fee:
Each branch circuit
$ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder ,:/ot included
""'ach pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limitedwenergy panel,
alteration, or extension (2)
Each additiona' inspection: (I) $58.00 $
\j~;t~~~~tt~5t~j't;~~~ARei2icANTi~'.Us.-~i,~~:~fffE~~;R~~2.~~~J(?;,;~,~
$ 63.00
$
00
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter ]2% surcharge (.]2 x [A])
(C) Technology Fee (5% of [A])
,TOTAL fees and surcharges (A through C):
.
$$'0
$
$ A 04/'l
$ 7-;-r:>ru
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00250
1505 Mo.H.A:V\(K BLVD
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
pe rmitcenter@ci.springfield,or,us
RECEIPT NO: 2010000249
RECORD NO: 811-SPR701O-00250
DATE: 09/08/2010
IOESCRIPIipN-,',ji:,:, :~::-;1i:€_,: .::';;':1::""'-$\';';'-: 'T\'S-~CCQ(JN]I(t61iE-".k:-itillAMQl.lt;lI:Q.tJj;- '., , -. 'j
Data / Telecommunications 224-00000-426102 $58,00
Technology fee (5% of permit total) 100-00000-425605 $2,90
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $6,96
TOTAL DUE: $67.86
l__PAYMEN];TjJ~E-";' J'AYbR:'-;-Ct>s~iEB-Nw:ci;A6d:';?:;.;r(jQIlliMEJIIS-:"c:"~;-- --f't'iZsY;_" ,AMOUNT,PA.ID'" - 'I
Credit Card
361191
TIC COMMUNICATIONS INC
$67,86
$67.86
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