HomeMy WebLinkAboutPermit Electrical 2010-11-15
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E~ctrical Permit Application
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225 Fifth Street. Springfield, OR 97~77' PH(541)726-3753t FAX(541)726-3689
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,/;' DEPARTMENT USE ONLY
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Penn it no.: 5/0 -00 709
Date: {( -( ) -( 6
This permit is issued under OAR 918-30~-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
," ,c'~OCAL~:'GOVERNMENT:'MPROvAl!~,~,:Htffii~1':"{
Zoning approval verified? 0 Yes 0 No
..,d.Cts..TEGORY;z;'OI' :.CONSl'RUCTIONl"'tb,,
IDesidential 0 Government 0 Commercial
illf~'ih~jOBlESI1'I:'jfNI;ORMATloN,;AN[j!Ji110C'A'1110N~i)(~Iff!~:':
Job site address: g- z.. Lot2..M, Loo I'
City: S.?I~~ State: oeL ZIP:97'f17
Reference: O~ 7.7 Z Z. Taxlot.:O 76l{]
'DESCRIPTION, 'OF-WORW'1/:<""'!::~'::'::-' ,"
C-J I I'll.;:- S ~LlI tN A- L
'PROPERTY OWNER
Name: Tt?tIN(~t:"'r1.. WII.~I'tI~o_
Address: 7 3 S c:; +
City: Sf>f' U "?l{"l7
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:
Business name:
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. "'.". "'-~~'H""M"EEE1SCHE[jLJIJ '~~"-"::wil":~" ~'"
;-.~<) :-~r{~i~~%~~r;'l>~,N~~;[?,:t~:lt~" . X, _ '. . .m'"... '~_E:;~~i,~ \''';~~~~l,.~;'~ ,~'?tA*: _._i~
" .. - '..' ~ " '~'-'- - - . ~ .,," , ',' ',- " Cost" Total
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Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. f1. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ $
dwelling service or feeder (2) 63.00
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) $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 $ 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) I $ 55.00 $ S-s
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder ,:ot included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a Iimited~energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
i{(k~iifit~:~4~~1~i1!i~rARei2ICANT:~:OS'E1%iti~;f~:}t;;~~~~~i:i~~:~,-.;;:}
(A) Enter subtotal of ;~~ f~~ $ S 8
(Minimum Permit F $~.,OO))
(B) Enter 12% surchafge('12'x [A]) $
T ~Arqh~j~el!O'.f>WEC~iDRK $
~ Tqq,~~Mj,li.iji,,/'flil1hrough C): $ 67&.'
ANDONI:U I-UJi
Signing supervisor's license no.:
Print name of signing supervisor
Signature of si inJlI~m'<lis0i' V
follow rules ado ed by the Oregon tllty
Notification Center. Those rules are set forth
in OAR 952-001-001 0 through OAR 952.001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1.800.332-2344). NOTICE:
\ ~~.<\. HIS PERM I
. ,\jY ~'-J i UTHORIZED
~~ COMMENCED OR IS AB
~ ,~NY 180 DAY PERIOD.
440.2584.J (9/08/COM) ~
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~OREGON
www.ci.springfield.or.us
'TRANSACTION RECEIPT
811-SPR2010-00709
1282 LORNE LOOP
ClTY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenler@ci.springfield,or.us
RECEIPT NO: 2010000821
RECORD NO: 811.SPR2010.00709
DATE: 11/15/2010
IDESCRIF!TION; .;; ..,~, "~'.',,:~"::;tr.!3'"::.;':,;,,;.,.j:'0r~' "}.~Ac:;,C0U~H"::C.QPE.t:~... .,.' AI\lt6.U~J~D.UE'..," . >
Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55.00
Balance of Minimum Electrical Permit Fees 224-00000-426102 $3.00
Stale of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $6.96
Technology fee (5% of permit total) 100-00000-425605 $2.90
TOTAL DUE: $67.86
r 'PAYMENT'['(,PEi to:""PA,{OR;+,rcAsHIERpBbli~sBY:....~:lc.6.MME~is~ ','.;;1:2:,,:';" ," ' .~.AMOlJNf:f>A1D;j1r.:'t .'
Credit Card
034791
jb electric
$67.86
$67.86