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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~" j 'PROPERTY OWNER . . LT~ S. S-O 0 ~v\.(,-6-N (F" . 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~. .. - ..~ 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 ~.' 'm_ "'''";'. i.. :j 0,: ~ . "/ .?~~{..~ ;..).<;";{;,. ;;.lc~r;-! j " . . i" ,1, "0.": ,.