HomeMy WebLinkAboutPermit Electrical 2010-8-19
225 Fifth Streett Springfield, OR 97477tPH(541)726-3753tFAX(541)726~3689
'-" .. [j~~~RTMENT USE ONLY.
S{R.-IO -000 Crfj
Permit no.:
Date: ~ -I 1- / 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.
'., . ':13bCAl' GOVERJIIMENT'AP,f!R0VA6"',,,.:',(;;'iT:f'l
Zoning approval verified? 0 Ves 0 No
:,. ;:,,:;,i'_,ii.\ICMEGORX:~(jF ':C(jJIISTRUCTION~:~:," .... 'cc,," :'....'.,
D Residential I D Government I DCommercial
t'i!l~~-g~oB;ltSIJ:E,'lINF(jRMA:TIOJllj;AN[jl1L:OCA;r,ION\\B.!i~li\in
Job site address: =-- 1 c:;a7 ;:; /71 ~ c.:r
City: !:,.('r"-IA.e I StateOi2... ZIP: 'i)'1<ti;:r~
Reference=-' I 7 0 ~ '1 L( 3 Lt Taxlot.: CO 3. 0 {
-.. "DESCRIPTION.OF'WORK";"\\'::";W::;"",,
Low liD! f- 1 ~ A....-c\'o 71//cf~"
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'PROPERTY OWNER . .
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Name:
Address:
City:
Phone:
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(1).
;..:: /71-"'-
I . ..,
State: 0<- ZIP: <=} 7L(03
I Fax: - ,
Signature:
,CONTRACTOR INSTAllATiON
Business name: n~,;"'",-, AlV
Address: 'lO '70 / ~ ler Y1/.i.[,!,-v::,.' ~CUJ
city:M,'/w<\.A,p I State: oR. ZIP~'2:JC
Phone:0'?-'1'1i?' ~32ci'z... I Fax: - -
E-mail:
CCB license no.: I BCD license no.: .
Signing supervisor's license no.: i-// 7 '-I L ;::7:-7,'
Print name of signing supervisor:Ch ~,I., t"'....~~~ ;'Zr. "tp"']<'1
Signature of signing supervisor:~~/~ ("j #/. /. L
" qUires you to
ATTENTION: Oregon ~a~;: Oregon Utility
folloW rules adoPte~hJse rules are set forth
Notification center'1 0 through OAR 952-001-
In OAR 952-001-00 . copies otlhe rules by
0090. You may obtain Note: the telephone
calling the center. (on Utility NotilicatlOn \
number for the. or1~~OO'332,2344). \ ~
Center IS ~t\ ,\V
",,,,, , ,moW", . ~~
wt~~~~~W~5~~~~EEE~SCHEOUbE~~~~~'~~~~~~~?r~1
INu~~er,"Iinspecii~.:1sperit~~ci:r.~ diy. ..Clls! 'c. . Total
. _ ._. .." '..,.:,."", "'" ., ""~ j. <~:\". : t;.ost /.
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 $52
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 $
401 to 600 amps (2) $158.00 $
60 I 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 4QP~ljl~~(;'). $ 87'00' . $
401 t06~'9Wh~^'1 i=Y.!IRE FS'UW:OWJI$K
Over 60du~rp~f!JtR'IfIKt$"'~TsdSidllQtlove
Branch ci;cuits: 'hA1<;'""',Al'),J<"-.~bno.r>>li.OlrUK,,.
lHJjl/llVIJ...-1~'V't:LJ't:I""'''J lpI .
a. Fee forlbrHhChn::]rcllih\l"n~OJr:aJUse of a service'or fe"eder fee:
"1'\1"1 I vv 1:)...l'I",.... PH
Each branch circuit I $ 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 ':lot included
$ 63.00 $
$ 63.00 $
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (I)
~ ~
(A) Enter subtotal ofab~es...
(Minimum Permit p6 $58.()0)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of[AD
TOTAL fees and surcharges (A through C):
$ 63.00 $
$58.00. $
~~
$SIJ
$ b "t.
$ ZJD
$ b 7 13~
.. .
S.~RINGFIE~. ..
-
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mm. OREGON
TRANSACTION RECEIPT'
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.cLspringfield.of.us
permitcenter@ci.springfield,or.us
RECEIPT NO: 2010000094 RECORD NO: 81 I-SPR20 1 0-00094 :. DATE: 08/19/2010
IJ:1:.ESC BIPTlciN~~;;;.;; f.. .;( .;\..~.;.. .. ',.;:z:;'t.'''i-;.~;~4 ~~ ,: ::.:.:p"ccdu NUQOE=;. ;.:;;J',;-,:.. .,~MdulII:r~DU_ Ec .~! . . J
Technol09Y fee (5% of permit total) .:100-00000-425605 $2.90
State of Oregon Surcharge (12% of applicable fees).,," 821-00000-215004 $6.96
Audio 1 Slereo 224-00000-426102 $58.00
TOTAL DUE: $67.86
r:;PAYMENT 'Tii'I'E;"2i;f'RAY.bR:t';;:;cAS8!E""DBOwtSBY~9=ciMMEIlli1".S<-$i..fr'/";'\;.. " '82i~';~.MQU_IIIJ2RAI[)i .
Credit Card delta av $67.86
519155
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