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HomeMy WebLinkAboutPermit Electrical 2010-10-7 Electrical Permit Application . B 225 Fifth Street+Springfield, OR 97477+ PH(541)726-375H FAX(541)726-3689 ~i~ii:iEPART:M'EN:WOS80Nfj:Yif ~li2~'ii'.!.-;-,,;.,.\,.".~-:';;~;:".:~-i;'!~t~~~~~Ji~ . ~ 5 fP-Z-Olo':> -00 4SC Permit no.: , Date: /0 ~ 7-/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 snspended for 180 days. ~Uit;;)l!'QQ~lli[~OME:g:f'lME;N1f~~gRRj:l,\Z'#.~, Zoning approval verified? DYes D No _~Aml;~~YLoJij[C'Qi\l$j'tiR.l!.I.c:ijJjfQN.~~g o Residential 0 Government ommercial ~liil~!I$TmiOlIIN~liiRM;a,.mi()!N'AN.l:)JJgOl!l*ijIQN~i11! Job site address: ~SJ e -""'"""''''__'''''''R"OhE''R'''r"EO. -W'N'E""R"""'F"',",".ti~.,,,...t.!,,,, E~1~~~5 -,---.:,5;~_.""_j;HiJt;"i:,,,O-A._w..-_____.j '{)xr;~~~~"lw\-w__ ~\t::'?i'f.-trjrN:~ Name: &-0/ LL'- Address: 'Pc::. aoy 70c{7) City: teu-.C>+.....6T StateOL, ZIP: 't?f('::' ( 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). Fax: Signature: ~B'[~:0Nm~Gmi;lRIINlilli~Ifb!'~\IRQi\l~~ii"~;r) 'Business name: J[ LA.{ Address: 3'6 -'-/ City: Phone: E-mail: CCB license no.: ~ S- BCD license no.: Signing supervisor's license no.: 100-5 Print name of signing superVisor: Signature of signing supervisor: I. t Ulre. YOLl 0 ref Dn Utility Notification Center. Those rul s ,re sr;\ forth in OAR 952-001-0010 through AR 952-001- 0090. YOLl may obtain copies of the rules by calling the center. (Note:the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). 440-2584-J (9/08/COM) Residential, per unit, service included: 1,000 sq. ft. or less (4) Each additional 500 sq. ft. or portion thereof Limited energy (2) Each manufactured home or modular dwelling service or feeder (2) $134.00 $ $ 2S.00 $ $ 32.00 $ $ 63.00 $ 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 $/$" 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, re/ocah'on 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 s~ction above Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase ofa service or feeder fee: Each branch circuit $ b. Fee for branch circuits without purchase ofa service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ $ $ Each additional inspection: (I) $58.00 $ , ."~.:..:_ %~!>t"~"1i:H:Ri!ic"WNffilliSE!il"y':j!Rl"'!!D~'~~ : D. ,~g~~1r~.t,-_",,~.__. ~'-d.~. "'. ..". _J~~,. ",.;)b~l!jjit ,.... (A) Enter subtotal of above fees (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [A]) (C) Technoiogy Fee (5% of [A]) TOTAL fees and surcharges (A through C): $ ;;. ,;,,/ www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2010-00450 3555 GATEWAY ST STE 103 CITY OF SPRINGFIELD 225 Fifth 5t Springfield, OR 97477 541-726-3753 permitcenter@ci,sprfngfield.or.U5 RECEIPT NO: 20 I 0000503 RECORD NO: 81 I-SPR20 I 0-00450 DATE: 10/07/2010 16ESC'Rfp"if0N,~~~jt:::;i:tf~~',ii~~~1}:;~'::~';;z2i1t;-o,~,t'~~~~:~~d~c.c_o~li~J~6~OJ;)~:~~:*'t7~>~tI~.M9J.J}.tfJii.J.g:~+~=T::, - < - "J Services 401 to 600 amps 224.;..000'!.o:.426102 $158.00 State of Or~90n Surcharge (12% of applicable fees) 821~,!?00:.215004 $18.96 ~!:.?Iogy fee (5% of permit total) 1 00-00000-425605 $7.90 TOTAL DUE: $184.86 r' . P&~E~J_.IY!iE,~';" PAY_QB:;''*'ii'CA~HI~Rlj2j!~;CI.rs[lY:;'/''~Qr'1!vII:N:r-S~~;'~5':ss_::,':-:;;;;:, o':,.-<;:~~QuNfpAID'!'-- . . '-i-..:.J Credit Card 220257 JEM ELECTRIC INC $184.86 $184.86