HomeMy WebLinkAboutPermit Electrical 2010-11-3
El~ctrical Permit Application
CITY OF SPRINGFIELD, OREGON
225 Fifth Strce~. Springfield, OR 97477+IJH(541)726-3753+ FAX(541)726-3689
DEPARTMENT USE ONLY
~e_L.a...:".~
_ S . i 0,
Permit noS: tV 20 i 0
Date: II -03 ,- L u
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
o Residential 0 Govemment It( Commercial
JOB SITE INFORMATION AND lOCATION
Job site address: 3 JtJ fro IIi errO f,( WJI
City: ?lIri~{I;dC State: 012. ..1 IZIP: tf' 7'177
Reference: I rJ/)Ii:?.,()(-r{:). I Taxlot.Ol rYY }
DESCRIPTION OF WORK'
I Lov.::> 1/0/'-A-fi,r
tPk.. . n + n{l~
PROPERTY OWNER
Name: CU^'~ OX-~ btnf\_\..}..\\.\...\-r-n .A
Address: '\In 'II T 1/ '" ~.'" ":1
City~ \. 0 m' Stater l.... ZIPq-'1.7 Y'
Fax:
Phone:
E.mail:
This installation is being made 011 residential or farm property
owned by me Of 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: !b-r }!,'0- E/ecIr'J-r. .:J4>c..
Address: I '1(;-0/ fif ;?,.,-epj
City: Or -<:!hJr- {'-~-':I- State: {)f/.. ZIP: q (()!L.::J
Phone:~3 .[:'c;'7t194A' Fax: 513-5!f7 /057
E-mail: tJ..m(p-,.~ {& IiluJL;~e1e~H<(. . ^. ~
CCB license no.: 'J.!,/t;/ I BCD license no.: 3'1- Lj t
Signing supervisor's license no.: If;} If/-S
Print name of signing superViso~ /7fJ~,. k,-~
Signature of signing supervisor: ~ ./ .
~\
~~
~
440.25~4.J (9/08/COM)
FEE SCHEDULE
Number of inspections per item ( ) Qty.
Cost Total
ea. cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63,00 $
Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
Services or feeders: installatioll. alteration. relocation
200 amps or less (2) $ 81.00 $
20t 10400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 5
601 to 1,000 amps (2) $205.00 $
Over J ,000 amps or volts (2) $469.00 $
Reconnect only (2) 5 63.00 $
Temporary services or feeders: illSlallation. alteration. relocatioll
200 amps or less (2) S 63.00 S
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) 5126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new. alteratioll. ex/ension per pallel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit
56.0015
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
S 55.00 5
$ 6.00 5
Miscellaneous f('('s: service orfeeder nol inelllded
Each pump or irrig<ltion circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (I)
$ 63.00
5 63.00
$
$
5(,J. 00
$ 63.00
558.00 $
APPLICANT USE
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technotogy Fee (5% of[AD
TOTAL rees and surcharges (A through C):
./100
$ b).
s 7.:f715
$ -:( . L
./~
5737/
SP.\~N~:IEL.. ~
~-'(-
~; \'~.1
.~S!~ OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00599
3106 PIERCE PKWY
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
pe rmitce nter@ci.springfield,or.us
RECEIPT NO: 20 I 0000706 RECORD NO: 811-SPR20 10-00599 DATE: 10/29/2010
[m:SC RIPTION:;; J: fE,,"':-;:; ;';!~~;::2f;:;':;::_', ~i"tJ:S~i..'.;':'ic.:[QUNJ1..C~b'E : :,-,:. ':'.;;::'.'4f"~N1Q.@.tDj:JI;:'; i",' "-1
Signal circuit(s) or limited-energy panel, alteration, or extension 224-00000-426102 $63.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $7.56
Technology fee (5% of permit total) 100-00000-425605 $3.15
TOTAL DUE: $73.71
l'PAYIVIE~I::tYPE.,:',':?;"AYbR ,.j -CAsHIE~:NMACHAD()..::.:1G:b1ill\lii;ilils:, :;::~'.;<;,,,'~7"7"'~0AM90NTf'AID' .. . ,.1
Credit Card
053417
PARKIN ELECTRIC INC
$73.71
$73.71