HomeMy WebLinkAboutPermit Electrical 2010-11-17
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Date: ((-/ 7-/0
Eied'iicaI Permit Application
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225 Fifth Street.Springtield, OR 97477. PH(541)726-3753. FAX(54 1)726-3689
This permit is issued uuder OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started withiu 180
days ofissuauce or if work is suspeuded for 180 days.
, ", ,-,., ,. FEESCI:lEDULE .
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Nu~J)0~T~~Hn.spectionsper'ite~'~)J. "Q~y.
Residential, per unit, service included:
. ;
Cost Total'"
ea. ~,cost ~
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
. :. .. '; LOCAL GOVE~NMENT 'APPROVAL'"'' '.': '.
Zoning approval verified? 0 Yes 0 No
'>CATEGORY OF CONSTRUCTION" -';, '.
~sidential I 0 Government I 0 Commercial
. JOB'SITE'INFORMATION' AND LOCATION '
Job site address: i 00 l Kou...;A('\. .~\J
City: C" ,;, r, _\ 11 I State 0l- I ZIP: COu:f)'
Reference:'\? d::r -:S;tl'2.. 3. I Taxlot: 61( t.'I c....
,,'.',' .i.i,;, '.: ;DESCRIPTION .OF WORK;'... '
~e r '" r- i.rr. "" c n \ ,'k ::J. 'o"""<'c.. '"
r,~r .;,..."" / u..~ ,~ e \e..~
:'i;; ',~. , ,. -';+:PROPERTY;,OWNER ,"':~9';';.,.,:,..,.: .
Name <rO~ l$(fr(..Ol.1
Address bO I ~OL.//1;'-I' A-V
City: S pf 0 I State:OI'L I ZIP <; "7l(77
Phone: - . .1 Fax: - -
t,OOO sq. n. 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: ins/aUation, alteration, relocation
$ql.~
$
$
$
$
$
200 amps or less (2)
20 I to 400 amps (2)
40 I to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
$ 81.00
$ 95.00
$158.00
$205.00
$469.00
$ 63.00
Temporary services or feeders: installation. alreration re/ocalion
-.,"
E-mail:
This installation is being made on residential or fann prope.1y 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family. This 201 to 400 amps (2) $ '87.00
property is not intended for sale, exchange, lease. or rent. OAR $
479.540(1) and 479.560(1). . 401 to 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
'.4',: '.".' . CONTRAC;ro~:tINSTAI:LiA'TI()N" -:'_ ~,?''t''" Branch circuits: new, alteration, extension per ponel
Business name: ~ ,rv:::.r=> ~ J:=\r-c}-" \..z.....r l ,....J'"l/' a. Fce for branch circuits with purchase of a service Or feeder fee:
Address: -z,"C1j( 0 c:,ec..~\( 1-0 Q..J Each branch circuit ;] I $ 6.00 $\),01:
City: .c; ~ (.&1<"""'" ) State: t5K-' J ZIP: q')Uc)r b. Fec for branch circuits without purchase of a service or feeder fee:
Phone:)''il-..... I Fax:St9,- 76. '3&-"'-1 First branch circuit (2) $ 55.00 $
E-mail: q . \ I .\ ~ ~ d- _ -.l-- Each additional branch circuit $ 6.00 $
eCB license no.: '1<:9.~<~ I Ben I:"".-me ~ . <IrQ.... Miscellaneous fees: service or feeder not included
Signing supervisor's license ~ /"\/ Y Each pump or irrigation circle (2) $ 63.00
Print name of signing superv .' ~J i,nc...r, Each sign or outline lighting (2) $ 63.00
Signature of signing supervi<" : / /7'. > V'" ~ Signal cir.ctlit or a limited-energy panel, $ 63.00 $
''7'' . . ~ ----- alteration, or extension (2)
~~~I~Et.~M\T SHALL EXP!r...-1l ,,;-;:WORK Each additional inspe~tion:(I).. .
AUTHORIZED ,UNDER THIS PERMIT IS NOT. '^ ~~~:.;;~'J;~,~'?~'~'APPLlCANT USE ·
COMMENCED OR IS ABANDONED FOOTENT~ON. Oregon ba t 1~Ahr~~ffr1~\m~yofabOve fees
^ NY 180 DAY PERIOD follow rll,as adopteTdh Y (Miniin~meP"mil Fee $58.00)
, . .. t' Center ose rI.J!->:-; i11t:: () l'V'"
~ Nottflca Ion. " n c.-O) "'"
0? 1"\ . OAR952.001.0010throI11B)IEnter.J.2v,.'su,CliargeCI2X[A])
~V In bt' OI.I~~~"'TrH::::'Ult::;,"),...,y.
\ex 0090. You may 0 am c .(<;:J.T~S,lj\'.'l1~g~.;f;>e(5% of[A]) .
\ \ ..~ lI'ng the center (Not" ....... ,
\," ncuam1ber for the Or~gon \ ~T:~,T^",re~stind1surChargeS (A through e):
tltl Center IS 1.800.3v2 2344).
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$
$
$58.00 $
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, . .:
$ '1:S~
'$ 1(<e.
$ l{b'5"
$ 1119'8
, -
440-2584-J (9IOB/COM)
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S~::~~~EL~
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~OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00733
601 ROWAN AVE
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
. permitcenler@ci.springfield.or.us
L j'AYIVIENT TYPE, fir. '. 'PAYOR;"CA$H'oRrOBOWlSBY" , ~c_QiYfJYIJ;~TS.."'""
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DATE,11/17/2010
l_'l~Jl.MO_U.N:u~li~' : '~;~_C:F ~ F~
$81.00
$12.00
$1116
$4.65
$108.81
," ,- AMoQ~tiTtFfAItr:;;,T~, ~~' J ';":4~il
RECEIPT NO, 2010000855 RECORD NO, 811-SPR2010-00733
lbE$C~!PI!,Q,r:4~i:?'11"';j~ 'W'~:::::~:~~~'~i/<": ' ,'.," r ",;/-f;:,'~.J"~~~': ",. ';~AGGbUNT~CoDEJ'!'.,";,~~2,
Services 200 amps or less . . -224:00000:426102 ~
Branch circuits with service or feeder each circuit 224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
State 01 Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
Credit Card
022398
SUNSET ELECTRIC INC
$108.81
$108.81