HomeMy WebLinkAboutPermit Electrical 2010-10-11
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,," ihectrical Petm{t A lication DEPARTMENT USE ONLY
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Permit no.:
225 Firth Street+Spl'"ingfield, OR 97477+PH(S41)726-3753+FAX(S4J)726-J689
Date: /0' ((-( <::::,
This permit is issued under OAR 918-309-0000, Permits are nontransferahle. Permit, expire if work is not started within 180
days ofissuance or if work is suspended for 180 days, .
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government ~ercial
JOB SITE INFORMATION AND LOCATION
Job site address: .:5'< ~ /J71?-12Ca../9 ;2d
City:JI'/2/Ntfrtcl. /) State:t);t ZIP: 97t.f7;1
Reference: '7D COD Taxlot.: OD
DESCRIPTION OF WORK
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ADT JOB :283-.CJIS-3f-b '
PROPERTY OWNER
Name: t!oMlKr If,.,c! I( Rvm d'.rc/G
Address:
City:':'
Phone:$"II/ - 1/3- 3 1/1
E-mail:
This installation is being made on residential or funm 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).
ZIP:
Signature:
CONTRACTOR INSTALLATION
Business name:
ADT Security
"Address: 2 815 5 W 153 rd [) r
City:
B ea v e rto n
ZIP: 97006
Phone: 503-469-7206
E-mail: spa t e @ a d t . com
CCB license no.: 59944 CD license no.: 26 - 2 09 C L E
Signing supervisor's license no.: 389 LEA
Print name of signing supervisor: Ken K r au 5
Signature of signing supervisor:
~ follow rules adopted by the Oregon Utility
,n'\' Notification Center. Those rules are set forth
V '. In OAR 952-001-0010 through OAR 952-001-
. 0090. You may obtain copies of the rules by
~ calling the center. (Note: the telephone
\J" number for the Oregon Utility Notification
Center Is 1-800-332-2344).
440-2584-J (9108/COM)
.,
FEE SCHEDULE
Number of inspections per item ( ) Qty. Cost Total
ea, cost
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) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or fceder (2) Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
60 I to 1,000 amps (2) $205.00 $
Over I,ODO amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders:: installation, alteration, relocalion
20D amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
40 I to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or lceder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not included
Each'pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighling (2) $ 63.00 $
Signal circuit or a limited-energy panel, / $ 63.00 $ bjP
alteration, or extension (2) ,
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A). Enter subtotal of above fees $ 63.00
. ..~.inimum Permit Fee $58.00) '. ""',:~:'l'~~' .
(B)Enter'ln~~(.12x[A)) . I.,., ),,7,,1>6'
(C) Technamg'~~rt.43H{I,ll t"t'ln~:~ ".. .
.li
TOTAL f~~a:qlm~~o .~' Irn '~0'Rl' 71'
COMMENCElJ UK I" I'.Dr ,..
r
f
'-,
ANY 180 DAY PERIOD.
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~OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00484
3995 MARCOLA RD
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECORD NO: 81 I-SPR2010-00484 DATE: 10/11/2010
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224-00000-426102 $63.00
100-00000-425605 $3.15
821-00000-215004 $7.56
TOTAL DUE: $73.71
tJPA YMENJT.YPE :";;+i,RAYQR_'i.CASHIERnDBo.Wl.SBYrf~<:<..biVIMl::Nts'" .c'-h,..:;,;,..,:,:~;-:;'--" -- -~MdiJNYP.AID-'. ~.'
RECEIPT NO: 2010000529
'D'E'S" CRI'P' TION' '.>-- ,,,-..-? -.;
~__".' 1:" """,'-,="',."],.4;,;;,,,
Fire Alarm
Technology fee (5% of permit total)
State of Oregon Surcharge (12% of applicable fees)
-.1
Check
3305421
ADT SECURITY SERVICES
INC
$73.71
$73.71