HomeMy WebLinkAboutPermit Electrical 2010-10-14
Electrical Permit Application
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CITY OF.8PRINGFJELD, OREGON
^...': "" ' " . I ~ .::
225 Fiftb Strtd+SpriDgfield, OR 97477+PH(S41)726-37SJ+FAX(541)726.3689
DEPARTMENT USE ONLY
C4::~ ~
-.. '&lJ' Permit no.: <31/ - s,.o~ 20/0-00
Date: /()-/o/- 20/6 '
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.
. LOCAL GOVERNMENT APPROVAL ...
Zoning approval verified? 0 Yes 0 No
'.,' CATEGORY OF CONSTRUCTION ..'
D Residential I D Government I G"Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 2600 I-Je.n.d eroSe> "'-
City: Eu q e..t\ "- I State: 0 R.. I ZIP: '17 ,,/ 0 3
Reference: 1<(;0 303 2t!)(jtJ IOf D I Taxlot.:
'. " .... DESCRIPTION, OF WORK;
~ODl1 f~J.<-/" /V,r sbf' fiuJ.."'l 12- we-,I:..., VCt-
.1 A" I D ,v .
I ,5~U"""""T ).trJo!" ,....6/15 f- 6 DI'_~li ~1....,..,7
, ".. PROPERTY, OWNER r"'Dv01 1i1~ c../'c
Name: ~(\l\\l\OI:-;1rS-~l. -
Address: ( 0 '{:No ;~
City: I{D )ffie.... I State:()l. I ZIP~ ( )
- '- I Fax: - .
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).
Signature:
. CONTRACTOR INSTALLATION ....
Business name: L R. g r<>...h l"'...... I"c. ,
Address: to p, We..s /;- "Q' ';:'.f:re"- {-
City: .s"'....i"a-h'e./d I State: 0 R. I ZIP: '1?Yi7
Phone5L/1-7I-i7- tC,3'2> I Fax:S4/-7'l7- 7/57
E-mail: Ir.b;;J.1ui.x "e..-(;. he.+
CCBlicenseno.: n'~9"l I BCD license no.: 2('l-e,C-
Signing supervisor's license no.: 49 L( LJ 5
Print name of signing supervisor: L",,,~,, B rcJ, L~]A ,
Signature of signing supervisor:~ I ~ /./ j{
/' JJf/
\}\\ \
~~
~
440-2584-1 (9/08/COM)
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FEE SCHEDULE
N bf' "'0 Qty. Cost Total
um er o. inspections per Item' . 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 feeder (2)
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) J $205.00 $20S L-
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary'services or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
40llo 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
$ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) ! $ 55.00 $ .(.
Each additional branch circuit 'Z"Z $ 6.00 $1 '3z. .(.
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline ligbting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Eaeb additional inspection: (I) $58.00 $
,"'C_ ", APPLICANT USE
(A) Enter subtotal ofabovefees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of[AD
TOTAL fees and surcharges (A tbrough C):
Gle.ofv1c'..JJ fP.-lIl1J,eVlev.)
70~ D'^-e...
$ 35.1
$ if 0 :!-Y
$ lip 9.
$3"ftj~
f?lf Ui
- 4 75J.s~ -
www.cLsprlngfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00520
2000 HENDERSON AVE
CITY OF SPRINGFIELD
225 Fifth 51
Springfield, OR 97477
541-726-3753
permitcenter@cLspringfield.or.us
RECEIPT NO: 2010000591 RECORD NO: 811-SPR2010-00520 DATE: 10/15/2010
!DESCRiPTi0Ni,L~~~j!';"~~~}~1IliZC~~':m:~CJ:tQlJijfELc'Jrr;ie~~~"AMj5l.!N~TjfiUE~~~c:li!";',l
Services 601 amps to 999 amps 224-00000-426102 $205.00
Branch circuits with service or feeder each circuit 224-00000-426102 $132.00
E~~_;;;i~1 Pla~.fl_,,~~,,~ 'C2?o/:- -"~ e;ct~I:.~f~;)-~~.:.--=~-=-~~---m:-OOo00-4261 oT -=-:~___.-Y84~~__
.s.t~!~-"f9r.e!l-"n_S.~~"h~!.!l"J1.~~~~ppli.,,~bJ,,_fee~L _ __._..__.___._.~~:~~0_0.9.:.~:.500~..____.._..____.____.__._____~::~,4~_.
Te-"h~()1?9Y.f",,(~o_0~pe.!:rl1i!.t~!L__.__ ... __ ._m__ .. ._ __.m. ._._ ____1 ~~:0~??0.:.~2.5~0_5_._._._ .. '_'.' $16.85
TOTAL DUE: $478.54
~AyMEWf"T;tfjE1iJ!'~~Ay,5R~li!c',[sHig[ITIT8oRBE~liI~~MMEN1:S~~~iJii~1lji~k;MOUN;fIIiAiD~iS~
-Select-
615145
LR BRABHAM INC
$478.54
$478.54