HomeMy WebLinkAboutPermit Electrical 2010-11-1
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Electrical Permit Application
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223 Flftb Slre"tSprlogn.ld, OR 97477tPII(541)726.J753t FA.X(541)726.J689
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Permit no.: 3
Date: II ~/ ~ /0
This pel'mll is Issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work Is not started within 180
days oflssuance orlfwork is suspended for 180 days.
......- ...".tOCALGOVERNMENT'APPR.OVAl ..
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Zoning approVlll verified? rn Yes DNo
i"/"CATEGORY.OF.CONSTR.UCTION ....
o Residential I 0 Government I ClI Commercial
.. ..'jOB 'SITEINFOR.MA TIONANDLOCA TION....
Job site address:33 77 Riverbend Dr.
City: Springfield I Stale: OR I ZiP: 97477
Reference: \\ IC ):~I)D r( ) I TaxlotJ~\CfL
... ..................DESCR.IPTIONOFWORK..... ..
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Electrical Remodel
.....................PROPERTY.OWNER.....
Name: Oregon Imaging Center
Address: 3377 Riverbend Dr.
City: Springfield I State: OR I ZiP: 97477
Phone: - - I Fax: - -
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. Tbis
property is not intended for sale, exchange, lease, or renl. OAR
479.540(1) and 479.560(1).
Signature:
... "'CONTRACTOR'INSTALLA TION
Business name: E C Company
Address: 875 Wilson St. Ste A
City:Eugene I Stale: OR I ZiP: 97402
Phone:541-345-0669 I Fax:54J.-345-1857
E.mail:' davido@e-c-co,com
CCB license no.:4 973 7 I BCD license no.:2 2 - 15 C
Signing supervisor's license no.: 3257S
Print name of signing supervisor: Will i am .. Coburn
Signature of signing supervisov.f . \-fJO J1. ( ,-\ A
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440-2584-J (9108ICOM)
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Residential, per unit, service Included:
1,000 sq. ft. or less (4) $134.00 $
Each additional SOO sq. ft. or portion $ 26.00 $
thereof
Limited energy (2f $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeder's: installation, alteratioll, reloca/lon
200 amps orless (2) $ 81.00 $
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 vollS (2) $469.00 $
RecOlmecl only (2) $ 63.00 $
Temporary urvices 01' feeders:'lns/allation, ai/era/Jon, 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, alteralfon, e.'\/ension per panel
a. Fee for branch circuits with purchase of 8 service or feeder fee:
Each branch circuit I $ 6.00 S
b. Fee for branch circuIts without purchase of a service or feeder fee:
First branch circuit (2)
Each additionBl branch circuit
1 $ 55.00 $ 55
29 $ 6.00 $ 174
Miscellaneous fees: service or feeder not. included
Ench pump ~r irrigation circle (2) S 63.00
Each sign or outline lighting (2) S 63.00
Signal circuit or a limited-energy panel,
./ alteration. or extension (2)
$
$
$
$ 63.00
Each additional Inspection: (I) $68.00 $
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(A) Enter subtotal of above fees
(Minlmnm Permit Fee SS8.00)
(B) Enler 12% surcharge (.12 x [A))
(e) Technnlogy Fee (6%of[A))
TOTAL fees and snreharges (A tbrough C):
S 229
S 27.48
S 11.45
$ 267.93
$P~IN.:-.\'l' E~
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;i?':":'~'OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00389
3377 RIVERBEND DR
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
penTIitce nter@ci.springfield.or.us
RECEiPT NO: 20 I 0000120
RECORD NO: 81 I.SPR20JO.00389.
DATE: 11/01/2010
I DESCRIPTIQN'-..: ':':;~
M.C.OUNfic.Q[)E"'!..., ',,,
224.00000-426102
224.00000-426102
821.00000.215004
100.00000-425605
TOTAL DUE:
!PA YM.EN.tTY~~.JA YOR. ::,rC~~HiER NMAcHAD0:.:;d:C.QMM.!'l'tIIs.::;';'''''': . .,.,.. ,
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5%()!permit total)
-AMQ.!.INT QUE
$174,00
$55,00
$27.48
$11.45
$267.93
'4MQ,U.IIIJ PAID ".
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Branch circuits with service or feeder each circuit
Branch circuits without service or feeder - 1st circuit
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Check
4223
EC ELECTRIC
COMPANY/ALBANY
$267,93
$267.93