HomeMy WebLinkAboutPermit Electrical 2010-11-4
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';DEPAR...ME,NT uSE ONlY';
Permitnoqjl-5fJt<Zt'/O-~' (053
Dale: I!-q-/()
This permit b issued under OAR 918-309-0000. Permit" urc nontransferable. Pennits expire if work is not started ll'ifhin 180
days ofissuancc or if\\'ork is suspended for 180 days.
8: '.:'.'LOCAL GOVERNMENT APPROVAL -c.v.' ....
. Zoning approval verified? 0 Yes 0 No
..' . CATEGORY OF.CONSTRUCTlON.' '.
o Residential I 0 Govenunent ll&Cornmercia)
JOB SITE INFORMATION',AND'LOCATION: . .'.
Job site addresS: /iji. 0 6- 51
City:c.PV'MU~I-e.M I Slate f)~ I ZlP:l(7'ri7
Subdi~rsionn~ 3{, Z.W Ifh C, Lot no.:
:. . '.. ,DESCRIPTION. OF WORK' . .'
Ant; 'A.,r ltIew eLu..-t~evs
~ re./"ude l,o",K
'. ..., PROPE~'OWNER ....
Namd"I~'''~U IA"IItUt4e.#c..fJ..e .
Address7f) 110>< fClO 700 v'
Citv~ c.~ I~~ I Stale: eA- I zIP:'/'fIl'
I Fax:
..:.....
n 1MtJ..... 1
Phone:
E-mail:
This installation is being made on residential or farm property
owned bv me or a member of my immediate lamil\'. This
properl)/is nol intended for sale; exchange, lease. or ren!. OAR
479.540(1) and 479.560(1).
Signature:
.CONTRACTOR'INSTALLATlON '.:"
Business name: \K(_ l.-I nr+vLt ./,1-.11'"\(
Address: Z-l<;;, -~(\ --;- )-t
City C - -rra rrJ I Slate: 0 V I ZIP <n4--n
Phone:-';;"'l ::'14/".'(' ..,., I Fax:'5tH '14b-~~5$
E.mnjl:~B~ <JK"-ElM..-.coM
CCB licen';' no.: 4'5 I z.~ I BCD license no.: LO-2.,I'c..
Si[IDing supervisor's license no.: '\-'il,""'S
Print name of signing supervisor:0n.tt:un " /.,..,,, J/Jj n t,,"~^':'r
'-"'I
Signlifure (}f signing supervisor:
/./
--c::::.J
440.2S84.J (9i08iCOM)
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:' " FEESCHEDULE':C;:C' .,' ',.,',' .' :.,...
~N~ber ~finsPc~tions-Pedte~'6. :} ~ Qti~':,:Cos~ ~ ; "_ToiaL.
_ "" _" _.e:a. . cost .
Residential, per unit, SPrVic~ included:
1.000 sq. fl. or\= (4) $134.00 $
Each additional 500 sq. fL or porticm $ 25.00 $
theroof
Limjted energy (2) $ 32.00 $
. Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Sel"\'ices 01" feeders: installation, afteraJioll. relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
..m. 600 amps (2) $158.00 $
~~:' $205.00 $
60 I to 1.000 amps (2)
. (h.'cr 1.000 amps or volts (2) $469:00 $ .
Reconnect only (2) $ 63.00 S
Temporary senic:es or feeders: installation. alteration, relocatimJ
200 amps OJ less (2) $ 83.00 $
20110400 amps (2) $ 87.00 S
401 to 600 amps (2) $126.00 $
Over 600 amps or 1.000 volts, see services or feeders section abm'e
Branch circuits: ~, alteraJian. eX/ension per panel
a. Fee for bronch circuits with purchase of a service or feeder fee:
'Each branch circuit $ 6.00 S
b. Fee for branch circuits without purch3se of a service or feeder fee:
first branch circuit (2)
Each additional'branch circuit
, $ 55.00 $""""
l- $ 6.00 S I'Z- ~
'Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $; 63.00
Each sign 01'" outline lighting (2) $ 63.00
$
S
.~
q3
Signal I.,.-ircuit or a limited~energy panel, I
alteration. 01'" ex1:ensioo (2)
Each additional inspection: (I)
.,' ".;',...,':' \, APPl.ICANT, USE
S 63.00
S
',: .
$I~O'
$ ,,,-):'
, -$Jl
$ I >2- ::> -
$58.00
(A) Enter subtotal of above fees
(Minimum Pennit Fee S58.00)
(B) Enter 12% surcha'lle (.12 x IA])
(C) Technology fee (5% of IA])
TOTAL fees and surcharges (A through C):
ZS'.Io f;(&:.Irri.J,.. f IoN! P.t\JltW
~
$
32.,-0
'11, I <6'1 ~
S;;}~~~.FIEL~
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~'OitEGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00653
1460 G ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield.OR 97477
541-726-3753
permilcenter@ci,springfield.or.us
RECEIPT NO: 2010000752
RECORD NO: 811-SPR2010-00653
DATE: 11/04/2010
tDESCRiptI6N77'0,7T'r:i;0'!ihC;7,'jf:"*";:?tf':\;:~:":-'}:;' -,: ":~~~c1:tuNf.c.!;>-P_I;" -;'? F<' "'AMOUNlDUE:-', i
Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55.00
Branch circuits without service or feeder - each additional 224-00000-426102 $12.00
Fire Alarm 224-00000-426102 $63.00
Electrical Plan Review (25% of electrical fee) 224-00000-426102 $32.50
State of Oreg.~n Surcharge (12% of applicable fees) 821-00000-215004 $15.60
Technology fee (5% of ~t total) 100-00000-425605 $6.50
TOTAL DUE: $184.60
L_J~_~'(MENlt1]:Y.B.1; ',,,~:';~~YOR;'::;;:'CA~EjEfl';BRicHARDSO'C9_MMI;i{(S~':::S "- _ -j:, 4" '-~ 7 AM9,UNrrMQ ,:,;' . " ;,;2
Credit Card
025990
JK GUCKENBERGER
ELECTRIC INC
$184,60
$184.60