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HomeMy WebLinkAboutPermit Electrical 2010-9-24 Electrical Permit Application ;t ~.-~.~ ,-,--,r''"''-'''''''~~~;_n "".~'~~~..' , , ",.GIIT'OF SF~,GFIEI:D,;OREGON.:: , n,," , ';r . , . '0.', '.. Ir..'Vi" ~?', _._~ ' ~ ~ -1 ,-1 225 Fifth Street+Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689 DEPARTMENT USE ONLY Permit no,: S"IO - 3''13 Date: 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. - lOCAL GOVERNMENT APPROVAL Zoning approval verified? ~Yes DNo CATEGORY OF CONSTRUCTION I E..Residential _ I D Government I D Commercial JOB SITE INFORMATION AND lOCATION Job site address: ::J..7S SO, 70Ul City: SPfW I State: oK I ZIP: CJ7Y 7lr Reference: I Taxlot: DESCRIPTION OF WORK ADO O\!TU75, (l.E(OGAT(i 5'w17GiI~S ref( g EDf<.oo/'>1S, EXIT L-r S PROPERTY OWNER Name: CIZvtt-C A-z-c/vt.- I) A- Address: '<:") / u (') l!-c:/':I)/J A-VC:- City: .,;.p ~L-Il\ I State: cn--I ZIP: ~ 7 Lf "t: Phone: - - Fax: - - E-mail: 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( I). Signature: CONTRACTOR INSTAllATION Business name; fASTS/Dc EL ((Ti( Ie Address: ~~)"S"3 80SC/lH IN. City: SPHD I State: 0 R. I ZIP: OJ 7 1./ 7?J Phone: - - 7Lft-ll(Cj9 Fax: - -731:,- Y96Q E-mail: RIC/(UST5IiJE If' 'r'AH60, (0 /VJ CCB license no,: I (JTJ 0 BCD license no,: )0 -VOS"C Signing supervisor's license no.: l./717S Print name of signing supervisor: 6G. E f( /( Jl-J (j- Signature of signing supervisor: ) -1JC\ H I~ , ~~~w ~~ 440-2584-J (9/08/COM) FEE SCHEDULE Number of inspections per item () Qty. Cost Total ea. cost 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 encrgy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 40 I to 600 amps (2) $158.00 $ 601 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, alteration, relocation 200 amps 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 Branch circuits: new, alteration, extension per panel a Fee for branch circuits with purchase ofa service 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) I $ 55.00 $55,0 Each additional branch circuit 5 $ 6.00 $ 30t.( Miscellaneous fees: service or feeder not includ~d Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited.energy panel, $ 63.00 $ alteration, or extension (2) Each additional inspection: (1) $58.00 $ : APPLICANT USE (A) Enter subtotal of above fees $ 8" s,ot (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [AD $(O~ (C) Technology Fee (5% of [AD $ '1 -u: TOTAL fees and surcharges (A through C): $ '7 C; '0-. w.NW .ci .springfield. or. us TRANSACTION RECEIPT 811-SPR2010-00373 275 S 70TH ST CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2010000394 RECORD NO: 811-SPR2010-00373 DATE: 09/24/2010 rDEseRleJfI0NT~mll!!!!l!l!l!ltl!l!ll!l!itUI!II!IIIi1IUUUU_il"_Ii!.i'AccoiIlN:flcoi;!E~ll!iiilll!illilllldiiUUlil1lilfp;M0wNj'ii5u~~UiljtlITjll Branch circuits without service or feeder -1st circuit 224-00000-426102 $55.00 Branch circuits without service or feeder - each additional 224-00000-426102 $30.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $10.20 Technology fee (5% of permit total) 100-00000-425605 $4.25 TOTAL DUE: $99.45 1"""P'P;YMENfriiYF!E:c'::T;:::TiF!AYOR::TTITcAs~r~R1iCC/\'lflEB!s~lIIi!coMMENi[s:1!IiiTllU13_~~!IIl!illljiiffilliiP!U:~M()iJNf':F1AiD'iIl_I!:0ii:j:;:1 Credit Card 02565c EASTSIDE ELECTRIC INC $99.45 $99.45 .