HomeMy WebLinkAboutPermit Electrical 2010-12-2
;. Efectrical Permit Application
225 Fiftb Street. Springfield, OR 97477.PH(541)726-3753+FAX(541)726-3689
DEPARTMENT USE ONLY
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l}lT:Yi OF SPRINGFmED,'OREGON
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Date: rz-z -10
This permit is issued uuder OAR 918-309-0000. Permits are noutransferable. Permits expire if work is not started within 180
days of issuance or ifwork is suspended for 180 days.
lOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? DYes DNo Number o(inspections per item () Qty. Cost Total
ea. cost
CATEGORY OF CONSTRUCTION Residential, per unit, service included:
o Residential .1 '0 Government IZC'O"mmercial
1,000 sq. ft. or less (4) $134.00 $
JOB SITE INFORMATION AND lOCATION
Job site address: .5 > Ss 12.\ vE'wt. 'iJ ~l\ Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City: s;>~ I State:Ot\. I ZIP: 97'177 Limited energy (2) $ 32.00 $
Reference: 170.3 '2..'2.00 1 Taxlo!.: 0410( Each manufactured home or modular $ 63.00 $
DESCRIPTION OF WORK dwelling service or feeder (2)
Ad~ IA<.7CfZ- 3 c,rc.......:-r-, Services or feeders: installation, alteration, relocation
/ 200 amps or less (2) $ 81.00 $
PROPERTY OWNER 201 to 400 amps (2) $ 95.00 $
Name: Pl~H~~ I-7'H 401 to 600 amps (2) $158.00 $
ilddress: ~c:> (for /1.(7 ? 601 to 1,000 amps (2) $205.00 $ ,
City: I:-u G-~er 1 State: 0 IL I ZIP: (( 7 '1'1 " Over 1,000 amps or volts (2) $469.00 $
Phone: - 1 Fax: Reconnect only (2) $ 63.00 $
- - -
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 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 ren!. OM 401 to 600 amps (2)
479.540(1) and 479.560(1). $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INSTAllATION Branch ~ircuits: new, alteration, extension per panel
Business name: e "SrSIDc ELEnf( IG a. Fee for branch circuits with purchase of a service or feeder fee:
ilddress: ~~)'S"3 80SCAH (..N, Each branch circuit I $ 6.00 $
City: SPHD I State: 0 fZ I ZIP: g 7 1./ 7'6 b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - 7'1 1-1 V<i 9 1 Fax: - -731:,. Y960 First branoh circuit (2) I $ 55.00 $5)'
E-mail: R /C.Ke "S75/i)E ~ YAHo6. (OM Each additional branch circuit 2- $ 6.00 $ /2
CCB license no.' I ('T7 JQ 1 BCD license no.: 10 -VOS'C Miscellaneous fees: service or feeder not includ~d
Signing supervisor's license no.: "/7),75 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: 06. Ef(. /()/-J(j- Each sign or outline lighting (2) $ 63.00 $
Signature of signings,!p'I\Yi,s,.\l,!;" 1- "red~ Signal circuit or a limitdl.-energy panel, $ 63.00 $
alteration, or extension (2)
AI I t:l' "VI. . - ~ theilJregon UIIIKY. $58.00
follOW rules adopted bYe rules are set forth Each additional inspection: (1) $
Notification Cenler. Thos hOAR 952-00i- APPLICANT USE
in OAR 952-00i -O~t~~~h:~~i~S of the rules by (A) Enter subtotal of above fees $ /:,7
0090.. You may 0 Note: the te\epho~e (Minimum Permit Fee $5~.OO)
calling the center. (on Utility Notifica\lOn
number for the. o~e~00_332-2344). , , ,Ql) Enter 12% surcharge (.12 x [A]),;.,!",' $ ~ o't
Center IS - , -,OTI ~(cJ.1echnqlpgy ,F't{.5.r.<>j'If[~JrHE WORK , $ 37r
HIS I, ""t~(." !;.i"'~i:J.1 I J. ' $/03
, UTH,;~~I_ 'F,~~" I-~~~ ~~~thtot.gl.C):
, -
.,
440-2584-J (9/08/COM)
'qMMENCED OR IS ABANDONED FOR
Y 180 DAY PERIOD,
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SPRING. .FIE.~
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...=?-'OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00670
3355 RIVERBEND DR
CTTY OF SPRINOFIELD
225 Fifth 81
Springfield, OR 97477
541-726-3753
permilcenter@ci,springfield,or.us
RECEIPT NO: 2010000950 RECORD NO: 811.SPR2010-00670 DATE: 12/02/2010
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Branch circuits with service or feeder each circuit 224wQ0000-426102 $12.00
Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55.00
State of Oregon Surcharge (12% of applicable "oe5) 821.00000-215004 ~~_.___.___ $8,04
Technology fee (5% of permit total) 100-00000-425605 _,_____ $3,35
TOTAL DUE: $78.39
!,?\I"AVffiENTj'y'PE;." ..' 'PAYOR~~;ii1\CASHiER"bBOWLSBY .: 'C.QI\'IJ'IL!"t'lI.$.+~ ~;';i". . ~-.AMOLJJIITMLI;L.-~:' ::...:.'-J
Credit Card
01584c
EASTSIDE ELECTRIC INC
$78.39
$78.39