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HomeMy WebLinkAboutPermit Electrical 2010-8-19 Elec.trical Permit Application ~ 225 Fifth Street. Springfield. OR 97477. PH(S41 )726-3753. FAX(541 )726~3689 SPRINGFIELD '':'':'f-X,-OW:~1 ~ ',', ".o;jW.,J _ ._~-;;;"~~":.,L,-\.\,";i.'y..-;' -...... . ........'''''..'',.., . "",,", ~d," :}~~~'~~L ~" "'.,~\ DEPARTMENT USE ONLY v }t( /10 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" 0 Yes 0 No CATEGORY OF ,CONSTRUCTION D Residential I D Government D Commercial '.i','c"JOB SITE INFORMATION AND lOCATION, Job site address: /5 Iq l:5 S.,-- 'l ./' I State7'JtV ZIP: 9 /7 / I' \ 'lO~~\Qfl..\- I T?xlOl \n\CO DESCRIPTION OF WORK .r'YI17J V h n ~{ c-c f PROPERTY OWNER Name /77;,../ -' ~ ~ /l) Q,J\ nn .fl., Address: 1579 77 L<:.:'T City: ~t'Z- I StateTru ZIP:~ff / / Phone: ' - - Fax: - - City: <::' , Reference: , 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 479540(1) and 479,560(1), Signature: CONTRACTOR INSTAllATION I Business name: u,a( U, . ~". ',. r-II..M J-r:-n IJ..(I Address: 4'C"3~ ~' llll/A A~tl~.::? D:1 City: hAl1~;;1.( I State: 011 zIP:nlot: Phon;t7!t-7114<<lf?1 Fax 9tllift4L6(/C; E-mail: /?rr." A/.v<~1.-":,, t..J',(::L. ~,I ~ (l(>,~ CCB license no,: /1. [?Qt;/ BCD license no,: "'1t')..t/{If:'(I I Signing supervisor's license no.: l/it.((J< .. P~int name of signing supervisor: ~ fttJ. '.tlTk~'",,-~ Signature of signing supervisor: --n... A 71 , J\ ' (/P / ~ 440-2584-J (9/08/COM) ~ J\:J' " " FEE SCHEDUL:E' '. ' . \, , Number of inspections per item () Qty, Cost I Total ea, cost Residential, per unit, service included: 1,000 sq, ft, or less (4) 5134,00 5 Each additional 500 sq. ft. or ponion I S 25,00 I 5 thereof Limited energy (2) I 5 32,00 I s Each manufactured home or modular 563,00 I 5 dv,'dling service or feeder (2) Services or feeders: installa/ion, alteralion, relocation 200 amps or Jess (2) 1/ S BLOO 1 S ~. fP 20 I to 400 amps (2) I 5 96,00 5 40 I to 600 amps (2) I 515B,OO I 5 601 to 1,000 amps (2) I 5205,00 I 5 Over] ,000 amps or volts (2) I I 5469,00 I S Reconnect only (2) S 63,00 5 Temporary services or feeders: installation, alteration, relocarion 200 amps or Jess (2) $ 63,00 5 20] to 400 amps (2) I S B7,OO S 401 to 600 amps (2) 5126,00 S Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteralion, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee; Each branch circuit I \ S 6.00 \ s b. Fee for branch circuits without purchase ofa service or feeder fee: Fir::;t branch circuit (2) Each additional branch circuit 5 55.00 I 5 5 6,00 I 5 Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited-energy panel. alteration, or extension (2) ':;:,:,;""' ',' , , , . '.... I .APPLlCANT 'USE. 5 63,00 S 5 63,00 I 5 I S 63,00 I 5 I $58,00 I S Each additional inspection: (l) I I (C) Technology Fee (5% of [A]) I TOT AL fees and surcharges (A through C): 1 s ~. ~ S Ll/U J 5 q ,"IV 5 /;' I VfI1 //1 (A) Enter subtotal of above fees (Minimum Permit Fee 558,00) (B) Enter 12% surcharge C 12 x [A]) TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 INWW. ci .springfield. or, us permitcenter@ci.springfield.or.us RECORD No:'s'ri-sPR20kb0691 _____','<0 ._ ;;~:;_>.4',.,: ..;:. ,f.i:',." ""i:"'.~'C', ,)t..,;t>t.,t "..,., .. " -. ,:' ,,':' .ic><> :.\, . ..... <;'+"A' MO'U""-N.'P~DUE""'" " , ?'sqp""'-"'c"';,,,,,liliSd(';:f,","'''.);:' 'AC,C,O_UNT:,C_OOE~ ".'::":::1.:;;;::", "',, _. -'~ . , '" -". 224-00000-426102 $81.00 1 00-00000-425605 $4.05 821-00000-215004 $9.72 TOTAL DUE: $94.77 r pAYMENT :TIVPE.',,;I;,PAY:OR,;''t::,CASHIER!NKio;c8,i,oo';'', CONHViENTS'::',-<>.::';''0'F!', - , . AMQJJNT.PAID ' Credit Card BEAR MOUNTAIN ELECTRIC Process credit card transaction per $94.77 LLC Chad at Bear Mountain Electric (DESCRIPTION' ,,' "" Services 200 amps or iess Technology fee (5% of permit total) State of Oregon Surcharge (12% of applicable fees) - ~,.", RECEIPT NO: 2010000090 DATE: 0811912010 , ....J 096422 \-, . . ~, .'>', .~-.. -- "'- .., ,.~. ~"~~"~~:~ ~':. ~'::.. '.:t:_~:.." ".~" , ,._; _'. ;'I ! ,j,. "r ", ';: Xi.j., ;i'n..:~(tll!.. 'ltl I ~~.j;.~:,~~::. .-;,:; ~;'if, ;?""" H ,," " ~,~::l'.;::':'SJ:G;".;;..:.~.. ~:":f!,J .':/k~'I~~'I:- 'I'J., '- ,/ ~" ,.