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HomeMy WebLinkAboutPermit Electrical 2010-12-2 Electrical Permit Application I~@w~m~~~ 225 Fifth s.......Sprlngfield. OR 974770P8(54I)726-3753.FAX(541)726.3689 G_~."'" I~ DEPARTMENT USE ONLY $10- 5$-; Permit no.: . . Date:! L/2- / 10 I I This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits ..plre lfwork is not started wltbin 180 days of issuance or If work is suspended for ISO days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? DYes DNo Number'" lospe<tkllls per lie.. 0' Qty. Cest Total CATEGORY OF CONSTRUCTION ea. cost 00 Residential I 0 Government I 0 Commercial Residential, per 0Dit, service iocluded: t,ooO sq. II. or less (4) $134.00 $ JOB SITE INFORMATION AND LOCAnON Job site address: 2-'01'0 C\.. T020 c.. , Each 3dmtional500 sq. II. or portioo $ 25.00 $ thereof City: <';;;>nI\Gr,t:.\~ I State: C 2- I ZIP:C\1'fo \ Limited energy (2) $ 32.00 $ Reference: I Taxlol.: 1'10:?a:}\O h manufactured home or modular ' $ 63.00 $ DESCRIPnON OF WORK dwelling service or feeder (2) A.:J, i.k.;.,"'...... B<6 .reo '...:.0.. -tc Seniees or feeders: installation, alteration, relocalion ,...... 'K-L"lc.<." C01..'~l.\"..\' 200 amps or less (2) $ 81.00 $ PROP TV OWNER 201 to 400 amps (2) $ 95.00 $ Name: ", I Ke: 1-lA,-a,,-.:w L 401 to 600 amps (2) $158.00 $ Address: ioe;!.., , ~~"".... '">-=. D.~. 601 to 1.000 amps (2) $205.00 $ City: Ev~~v\.L I Slate: cP- I ZIP:'ll'-l 0 I Over 1,000 amps or volts (2) $489.00 $ Phone:9-!I-SI'I--4'7'(\'>' I Fax: - - Reconnect only (2) $ 63.00 $ E-mail: "rc".iY'l ,S~'1.r""'/'- .- (\oL~ Temporary semccs or feeden: ;nsta/Ioti~n. alteration, relocation . This instalfation is being made on residential or furm property 200 amps or less (2) $ 83.00 $ owned by me or a member of my immediate fiunily. This 201'0400 amps (2) $ 87.00 $ property is not intended for sale. exchange. lease. or renl. OAR 479.540(1) ",!d 479i\'(l). . <<11 to 600 amps (2) $128.00 $ Signature: (AU;: , Over 600 amps or 1.000 volts, see services or feeders section above CONTRACTO INSTALLATION Bnueh circuits: new, alteration, extension per panel Business name: L-Kr Gkc.h-.'C a Fee for branch circuits with purchase of a service or feeder fee: Address: iZl51 &.-""",* S\-. Each branch circuit I I $ 8.00 $ City: [:'-"'.:....e.. I State: Dr- I ZIP: Q7'105 b. Fee for branch circuits without purchase ofa service or feeder fee: Phone:j'fl-lz,- tal. 7 I Fax: - - Fim branch circuit (2) 1- $ 55.00 $ E-mail: Each additional brancbcircuit $ 6.00 $ CCB license no.: I 85ti9l., I BCD license no.: (,<1~5 MisccllaDeoUS fees: service or feeder not included Signing supervisor's license no.: ~CI3L( S Each pump or irrigation circle (2) $ 83.00 $ Print name of signing supervisor: Koba-t- $. \.J ()(.l"iL., Each sign or outline lighting (2) $ 63.00 S Signature of signing supervisor: -fU.-..f2 4. Cfl. f Signal circuit or a limited..energy panel. $ 83.00 $ altemtion, or extension (2) V V Each additiowtl iDspeetioa: (I) $58.00 S APPUCANT USE (A) Entersuhtotal of Bhove fees $ SO IiV (Minimn.. Permit Fee $58.00) ~\Q (B) Enler 12%sureharge (.12 x [All $ (.. ~ (C) Technology Fee (5"10 of [A]) $ '1."1 u '\ . TOTAL re.. aDd oDrcbarg.. (A throDgh C):. $Lt7't'" -' fJ-f 440-2584-) (9f08ICOM) ... . www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00359 2818 EL TORO CT CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 permitcenter@ci,springfield.or.us RECEIPT NO: 2010000948 RECORD NO: 81 I-SPR20 I 0-00359 DATE: 12/02/2010 lbESCRIPII0j'h';;;&:f~-.,. .:' "'J .:t}-*;X<<':_'\'t-.c;~c_c:.6Jj~ji.cJ,~b.g::/ '" { ~MP.Ut.lJ~Ql,!E.-';'L ./' .J Branch circuits without service or feeder -1st circuit 224-00000A26102 $55.00 Balance of Minimum Electrical Permit Fees 224-00000-426102 $3.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $6.96 Technology feej~% of permit total) 100-00000-425605 $2.90 TOTAL DUE: $67.86 1~1I"A.. YME'N. l,;r,YPE:; :CPAV0R"'-'jf/CASHiEiCcCARPENfER"c6ivnviEN:fS['iJ.,";'-:Y-/~~, ;i, ,'<AMOUNT, PAID . '.'.-'~_" -J t ___ ~ ~~............_. ....__..."";_"'~._.,_.,.___W,h__.;...,,_,~~.~~... .' _ . _ _ ~ Credit Card 46777z KINGSLEY ELIZABETH A & MIKE HARGROVE $67.86 $67.86