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HomeMy WebLinkAboutPermit Electrical 2010-11-5 Irle~t.rical Permit Application ""1 j'O:- c~~ , _ .~ + ~ ' :- 1-'" - + ~ ~ ""= f': 1~!lFY OF SPRIN~Ji1l!!J[P'. -q~G~N_ . 225 Fiftb Street+Spdngfield, OR 97477+PH(541)726-3753+ FAX(54 1)726-3689 ~ DEPARTMENT USE ONLY Sf,t'Z-Clc~ E:, "t Penn it no.: Dat~: //""5~(O 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 esidential 0 Government 0 Commercial JOB SITE INFORMATION AND lOCATION Job site address: 'D ~ \ If fI Lv City: 5 r' fl., State: D><.-- ZIP: Reference: 17C 5 'Z Taxlot.: 0 DESCRIPTION OF WORK e-h f1;v< --zaP w- Name: Address: City: 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). 7 Signature: CONTRACTOR INSTAllATION .rp I ~ le.d-~' e. V Signing supervisor's license no.: :t- Print name of signing supervisor: (J Signature of signing supervisor: :t- . on law req Ire:; ,uu '" . ATTENTION. Oreg d b the Oregon Uti!,\\ follow r~les adopteTh.!se rules are set ionn NotificatIOn Center. h gh OAR a~2.001. . OAR952-001-0010t rou . "".eb- In obtain copies Oflhe n,,~'" - \ 0090.. You may (Note: the telephone n J calling the c~n~;'egon Utility Notification, t\y ..;:;;J number6~~:e:is 1_800-332-2344). \.JV ,\$ ~t-P \~# . ~~ 440-2584-J (9/08/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 additionat 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) V $ 81.00 $ '><-1 201 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, relocation 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 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 feeder fee: First branch circuit (2) $ 55.00 $ Each additional branch circuit $ 6.00 $ Miscellaneous fees: service or fteder not included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel, $ 63.00 $ alteration, or extension (2)' Each additional inspection: (1) $58.00 $ APPLICANT USE (A) Enter subtotal of above fees $ (Minimum Permit Fee $58.00) 8'1 (B) Enter 12% surcharge (. t2 x [All $ ?72. (C) Technology Fee (5% of[A]) $ l(of" 1t;~i}C ~s and surcharges (A throggir C), $ 91./71 HAL EXPIRE IF THt .. THIS PERMIT S L AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. ... www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00669 530 SPRINGDALE AVE CITY OF SPRINGFIELD 225 Fifth 51 SprjngfjeJd,OR 97477 541-726-3753 perm itcenler@ci.springfield.or.us RECEIPT NO: 2010000774 RECORD NO: 8 I I-SPR201O-00669 DATE: 11/05/2010 !PE~.BWTIQ_~ -jY ;~,:_.:",-,-" ?"it;.;,~ ';;- l';;":ilf!:l':iiJ,-;,zv'12ii8'<:<:QUNJiG.Q!'!E;" .. ,C:" '-"AMOJJJlJ'J?J,l.!;;.7F. : .'j Services 202. a"!ps or less 224-00000-426102 $81.00 Technology fee (5% of permit total) 100-~000i425605 $4.05 State of Oregon Surcharge (12%01 applicable fees) 821-00000-215004 $9.72 TOTAL DUE: $94,77 1- P.~J:MENTTYP~;:~,:t~'yOR:'-;;C1'cSHjEf'-bBi:iWLSBy:,uYC9J'~_N1J:NJ:S"'t';.';:: ,'. " ~,,;At~'LQuQtlI,eAID;-,-;'.... .~ Credit Card 628828 BOB FISHER ELECTRIC INC $94,77 $94,77