HomeMy WebLinkAboutPermit Electrical 2010-10-18
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Electrical Permit Application
CITY OF SPRINGFIELD,',OREGON: .
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225 Fifth Street. Springfield, OR 97477. PH(541)726-375lt FAX(541)726-3689
DEPARTMENT USE ONLY
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Date: 10 -18 -/0
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is nol started within 180
days of issuance or if work is suspended for 180 days.
, , ':LOCAL>GOVERNMENT 'AP,f>ROVAL:,.:,."",>t:,':/, ;'~~'~"'::.!:;;!:#:t~{M;~~1?*~~f.;T~I5EE-~SCflED:O rjE~:~:;~:r?i\i~ft*&%\*1~~~~~}~\'nt
DYes DNo , " Total
Zoning approval verified? .Number' of.insi)t~Cti'o'ris,per it~m' (.). Qty. Cost ,.
:,.',','::CATEGORY >bF;'CONSTRUCTION;.;~ ",'., . :. ,..,....-,. .,'" ,'-"'. ".,.. " ~, . ea~' cost
Residential, per unit, service included:
D Residential I D Government lE-commercial
~4!'.~~tOB;i.SITE;'INI;QRNiATIOJi.WANtl~'~O:CAtION:\"ii~9~;; 1,000 sq. ft. or less (4) $134.00 $
Job site address: 10 I .:sOfL... St- , Each additional 500 sq. ft. or portion $ 25.00 $
" thereof
City: S~~,e'I!"~f1 r State: ce.. ZIP: Limited energy (2) $ 32.00 $
Reference: 170 Z 3/(S'O I Taxlot.:OStO C\ Each manufactured home or modular $ 63.00 $
DESCRIPTION: OF WORK""" ", ,",',,",;". dwelling service or feeder (2)
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A/~-w c.(~, + +.::- ~AI( $1#"'- t Services or feeders: installation, alteration, relocation
'"?b I ~ SIC .... 200 amps or less (2) $ 81.00 $
I'ROPERTYaOWNER 20 I to 400 amps (2) $ 95.00 $
Name: t:; (.....dl v-r L-*"t:r C.::---k. 40 J to 600 amps (2) $158.00 $
Address: '8 SS-_ / $c?Vb-LA 12.../ . 60 J to 1,000 amps (2) $205.00 $
City: ~c.L ("..f:r"".i I State: oL- ZIP: <17C/OZ. Over 1,000 amps or volts (2) $469,00 $
Phone: , - Fax: - , Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less (2) $ 63,00 $
owned by me or a member of my immediate family. Tbis 201 to 400 amps (2) $ 87,00 $
property is not intended for sale, exchange, lease, or rent OAR 401 to 600 amps (2)
479,540(1) and 479,560(1), $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INSTAllATION Branch circui.ts: new, alteration. extension per panel
Business name: __--r8 ':::1_ ok., " -:;::;.V- a, Fee for branch circuits with purchase of a service or feeder fee:
Address: t(6E~ ';;.n. 1 ,/~ ,("/ Each branch circuit T $ 6.00 $
City: r;;UA~ I State: /fR.....- I ZIP: - . 'H).2.- b, Fee for branch circuits without purchase ofa service or feeder fee:
Phone: :'7E/ -btf'1-.s:?-7'" I Fax: 5:Z,//~.f(O:J-9,;J.9t First branch circuit (2) 1 $ 55.00 $S!"'
E-mail: . '_1 ~ 0, .1 _..L " Each additional branch circuit I $ 6,00 $1-.
~I,.,et. ~
CCB license no.: 101/9 ~q I BCD license no.: 3"7 - ".-(:::- Miscellaneous fees: service or feeder ~ot included
Signing supervisor's license no.: SC>7.:2~ Each pump or irrigation circle (2) $ 63.00 $
. Print name of signing supervislu-~--r-, - =- J... k Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: '\( ~~ Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
ATTENTION: Oregon law requires you to Each additional inspection: (1) $58.00 $
'it:y~~\\&~';R'i~t~~~~AR~liCA~Tf1lJs.El:~,;t:'?}}}~.!:,;t:~tij~~'..:(;~" ';.' .7
foHow rules adopted by the Oregon Utility NOTICE :(A) Entersubtotalof~bo~RK
I Notification Cenler, Those rules are sel forlh $ b(
In O~R 952'001-0010 through OAR 952'001- THIS PE ~~}ltjnB'1~,ll1.fq:D\ilIFe'i $~8,.~ ,,"T
0090,. You may oblain copies of Ihe rules by AUTHOF IOOIJ:~rllli%\sJrctltlig'eJ: . . $ 73Z
calling the center. (Note: the telephone -." ...
number for the Oregon Ulility Notificalil(}.d COMME \'(Gf:feJilIl~E'(5~.'t,f'[A]) . $ .30,S"
Center is 1,800,332,2344). ANY 181,1 f@TAil=UW~)rid surcharges (A through C): $ 7/1:!
440-2584,J (9/08/COM)
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00530
101 30TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@cLspringfield.or,us
RECEIPT NO: 2010000605 RECORD NO: 8IJ-SPR2010-00530 DATE: 10/18/2010
[bESCRIPTION"lY;"I, 'x '-:'-Y~:>!.~::h_'-: .,"*-ir7,'::-1h" -~.,,_;:;_ . 'x;; ~~.:c;:QUNif..:(tO:QE..1:':li-f:,;;-_-:-AMO_UN"--b_UE'_
Branch circuits with service or feeder each circuit 224~00000-426102 $6.00
Branch circuits.without service or feeder ~ 1 5t circuit 224-00000-426102 $55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $7.32
Technology fee (5% of permit total) 100-00000-425605 $3.05
TOTAL DUE: $71.37
Li.e8Y!,~'-EN:t tY~i:}.:J>0 YO~-Y:'(CASHiER~bBpWLSBY"~ ,CJtIYlM~NIS";::-'i.;:r,/:{,;:'u,-~:;;:!;:-;.'iti.M0l.JNt-PAID - '..J
Credit Card
009687
JB ELECTRIC INC
$71.37
$71.37