HomeMy WebLinkAboutPermit Electrical 2010-9-29
EI.al Permit Application
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a'JrroF SPRINGFIELD ~OREGON .",
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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.
S10-0/0 r
Pennit no.:
Date:
'-Z.1-10
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.
D Residential D Government ommercial
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Job site address: I Lf ~
City: OS :P r
Reference: I?C:1 'Z '" Z. Taxlot.:C>S'So 1
DESCRIPTION OF WORK' .
:.J-~ \ ,. U "l: ",,~ t:-lr~r Services or feeders: instal/alion, alteration, relocation
200 amps or less (2) $ 81.00 $
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PROPERTY OWNER 201 to 400 amps (2) $ 95.00 $
Name: r=.A ~t) t.\L. ~'^"~ r _~~ 40] to 600 amps (2) $158.00 $
Address: :IS e t:> 614w1.~~-~ 60] to 1,000 amps (2) $205.00 $
City: S ~~ F'b. State: OiL ZIP: 9?ft7.., Over] ,ODD amps or volts (2) $469.00 $
Phone: Fax: Reconnect only (2) $ 63.00 $
. toUt" _ ":'TemnOl_rarv services or feeders: installation, alteration, relocation
E-mail: U " -,'''.
This installation is being made on residential or fann 4l~lel e II! r!!~tJ'\,~js}fy',,~., $ 63.00 $
owned by me or a member of my immediate family{qrNjn~JO le'.boftl~lo 46\j~S3(ql BU;J~~:J $ 87.00 $
property is not intended for sale, exchange, lease, "iClllla-
479.540(1) and 479.560(1). l/lJOJ18S 0 6 c1JUI' _ s OA '0600 $126.00 $
Signature: Alwin u~~~:el I~. ~~Io!dPDmltnP~otJj~ffi1,r.9h~!see semces or feeders section above
41 '.;':!}=~Ju_on"" ,
no SaJjnb. J IiIIlRrlll\~\,~rrc~i~jl!IJw,NI{lf~ion, extension per panel
a. Fee for'b'rahW'c4t(!ui~th purchase ofa service or feeder fee;
LOCAVGOVERNMENTAP'PROVAb' '" .."""'"
Zoning approval verified? 0 Yes 0 No
.. .'.C,l\TEGOR'(iOfCQNSTRUCTION';Y. ",
CONTRACTOR INSTALLATION
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Business name:
City:
Phone:
E-mail:
r~~j~' ,;:;i;t',~;(~t~:~{i~'~,'~ff~\:W;:<:i-':'I5EEf~SCH E,P.LJ IBE;(ii}f,~?Vfp~~0,W~\;f:~~~~W~flf:
N~mb,er~fin,pe~tio~~p~r.ite~()/ 9ty.. ~~~t ;'1.1~~1
Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
$134.00 $
$ 25.00 $
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$
$ 32.00
$ 63.00
$
Each branch circuit
I $ 6.00 $
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2)
Each additional branch circuit
I $ 55.00 $ 55
Z. $ 6.00 $ I 'Z.
!..(:;:.- Miscellaneous fees: service or feeder ~ot included
Signing supervisor's license no.:
Print name of signing superviso
Signature of signing supervisor:
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
$ 63.00 $
$ 63.00 $
$ 63.00 $
Each additional inspection: (I) $58.00 $
i'~:f:;;,i~X,i~~it~~~t~t~N~~t~~;tJ~~~~~;e'lj'fC_A'Nftb:iJ'$'Eki;,:t{~~;{~~}','i:,:~\~~X{'.:;'~;;J~:;', ';',:,;:
NOTICE: p !..AJ Enter su~m(l).,q~above fees
THIS PERMIT SHALL EX IttM1.Iim ~~J.I.!1O'ee $58.00) $ b 7
AUTHORIZED UNDER TH.I ~rCharge (12 x [AD $ 80'1
COMMENCED OR IS ABA ~ .. '3
ANY 180 DAY PERIOD. C) Technology Fee.(5% of[AD $ 3 :s-
TOTAL fees and surcharges (A through C): $ 7X 3 ,
,-
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440-2584-J (9/08/COM)
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.h OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00105
514 Q ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenler@ci.springfield.or.us
RECEIPT NO: 2010000418
RECORD NO: 811-SPR2010-00105
DATE: 09/29/2010
IDESCRIPTION .:..: ','<. :'.~-- ,
,. j ... ~~
~1. ::
. .',' ~-;t,:-W.;, ~.:: -AG.G.O,UN'j-:::.CJ>.OI'::?{f """,;;c.2:~i\ltQlJ~LQ.lJE: '.' ',,' ,< ."
224-00000-426102 $12.00
224-00000-426102 $55.00
821-00000-215004 $8.04
.100-00000-425605 $3.35
TOTAL DUE: $78.39
'?CO~.ME}i!~:;+f "";' ',::- ,;,.,;. 'iV;::;;.:AMbUNTP'AII)'':.
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Branch circuits with service or feeder each circuit
Branch circuits without service or feeder -1st circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
I "PAYMENT TYPE':: . PAYOR'r~;'CASHiER'bBOVVLSllY~"
Credit Card
035980
JB ELECTRIC INC
$78.39
$78.39