HomeMy WebLinkAboutPermit Electrical 2010-10-19
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Electrical Permit Ap
DEPARTMENT USE ONLY
Si>tlZO/6- 00 S3
Permit no.:
225 Firth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726-3689
1!./-!7fS2: fiJ/,! /emf) CCY'7 P ~7)3-%~7J;' Date: /6-/7-/0
This permit is issued under OAR 918-309-0000. Permits are nontransferable. permi~Pire if work is not started within 180
days of issuance or if work is suspended for 180 days. .
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
Commercial
OCA TION
6/
ZIP: cJ1'I7J
Reference:
.56!,tJh r
ADT JOB
O/h
Name:
City: ZIP:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate fumily. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Business name:
ADT Security
Address:
2815 SW 15Jrd Dr
City: Beaverton ZIP: 97006
Phone: 50 J -4 69 -7 2 0 6 Fax: 503-469-7114
E-mail: spa t e @ a d t . com
CCB license no.: 59944 0 license no.: 26 - 209 C L E
Signing supervisor's license no.: 38 9l E A
Print name of signing supervisor:
Signature of signing supervisor'
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\\j':S1tY-~
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440-2584-J (9IOB/COM)
FEE SCHEDULE
Number of inspections per item ( ) Qty. Cost Total
ea. cost
Residential, per unit, service includ~d:
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 feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
40 I '0 600 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 $
Temponlry services or fceders: insta{[alion, alteration, relocation
200 amps or less (2) $ 63.00 $
20 I to 400 amps (2) $ 87.00 $
401 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 tor branch circuits with purchase of a service or feeder fee:
Each branch circuit I I $ 6.00 I $
b. Fee for'branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees; service or fteder not included
Each pump or inigalion circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, / $ 63.00 $bJ
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ 63.00
(Minimum Pennit Fee $..~.OO)
(B) Enter 12% surcharge (.12 x [A]) $ 7.56
(C) Technology Fee (5% of[A]) $ 3.15
TOTAL fees aod surebarges (A through C): $ 73.71
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.':::. OReGON
www.ci.springfield.OLUS
TRANSACTION RECEIPT
811-SPR2010-00538
3000 GATEWAY ST
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541~726-3753
perrnitcenter@ci.springfield.or.U5
RECORD NO, 811-SPR2010-00538 DATE,10/19/2010
- ;,,:"";{i-~'07_~"Ai(':, ,"';;".':';' ."i;C:;;'CC':'O U'NT:CODE ',:::ii,{{'t_, . AMOl.JN'f'bUE' " j.
- - -"~"""""'-"~' _..'....~._--,.. .~~....._.-.-_._~~_.-...
224-00000-426102 $63,00
100-00000-425605 $3,15
821-00000-215004 $7,56
TOTAL DUE: $73,71
Gpi>.YMENtTYP~;;-J -'PAY6R'--,'tAsHIEi{DB6WilSB:i;,:;:;-,G_QMMg~IS1f.wJ,;:i-_: ,'-' " ':-0;:~::~M.9U~;rgAlb
RECEII'T NO: 2010000608
1.Qg.~CRIPTIONe'" ';i;" '.',,;
Security Alarm
Technol09Y fee (5% of permit total)
State of Oregon Surcharge (12% of applicable~ees)
:.J
Check
3307902
ADT SECURITY SERVICES
INC
$73.71
$73.71