HomeMy WebLinkAboutPermit Electrical 2010-11-29
Electrical Permit A
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DEPARTMENT USE ONLY
225 Fifth Streett Springfield, OR 97477. PU(541 )726-3753. FAX(541 )726-3689
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Date:
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
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lOCAL GOVERNMENT AP-PROVAl FEE SCHEDULE
Zoning approval verified? ~es DNa Number of inspections per item 0 Qty. Cost Total
---CATEGORY OF CONSTRUCTION ea. cost
.tf"R.,sidential D Government I D Commercial Residential, per unit, service included:
1,000 sq. ft. or less (4) , $134.00 $1:14
JOB SITE. INFORMATION AND lOCATION
Job site address: .-)'74''''/ #r.r4r !c1tVl Each additional 500 sq. ft. or portion '-( $ 25.00 $/I:rt:::
thereof '
City: 5,t:'f"M'1f<2.f'l./ State:t?A' I ZIP: 17~Jl Limited energy (2) $ 32.00 $
Refere~ce: ftt"'l'/ -(f 1/;// ..SI7fC/.o Taxlot.: 0 I z,.U Each manufactured home or modular $ 63.00 $
I BQ::Z.04/tf DESCRIPTION OF WORK dwelling service or I"eeder (2)
~ u./ W/Z.:>,c-"'/(C,lf';/l Services or feeders: installation, alteration, relocation
, ,/- ",L Ae."./~/Zc:.P 200 amps or less (2) $ 81.00 $
PROPERTY OWNER 201 to 400 amps (2) $ 95.00 $
Name: _ 0/f /7 <4/1 M?/-&(tt~r-- 401 to 600 amps (2) $158.00 $
Address: 5'~ q A-!p/Zrrx;: t:>c/3 601 to 1,000 amps (2) $205.00 $
City: ?" ,..ie:' <2. State: c/f... I ZIP: '77o/p'?--.... Over 1,000 amps or volts (2) $469.00 $
Phonesrl.J'd. 0{ 9tS I Fax: .~ Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residenlial 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 rent. OAR 401 to 600 amps (2)
479.540(1) and-479:560(1)~ $126.00 $
Signarur(:~ Over 600 amps or 1,000 volts, see services or fceders section above
/ CONTRACTOR INSTAllATION ~ Branch circuits: new, alteration, extension per panel
,Business name: I- \ , H?Y'1-.l'lt" 5\) c.. ~ a. Fee for branch circuits with purchase of a service or feeder fee:
Address: {.,<.,ci()"3 'F C'V\)(A~\w",,~r'- \');:~ \
I \ Each branch circuit $ 6.00 $
City: "R-e.~\A. State: OR I ZIP: 9fn( \? Fee for branch circuits without purchase of a service or feeder fee:
Phon.Sitt -)8~;:X>J I Fax;s'l( -323' U-Cf? \First branch circuit (2) $ 55.00 $
E-mail: beh-aA"\," ;L~rVl'c(',e 7',,,\..0.0,(01)'\ '~ach additional branch circuit $ 6.00 $
CCB license no.: q7 80~ I BCD license no.: Z.D-3(,,~L M~~cellaneous fees: service or feeder not included
\ Signing supervisor's license no.: ~q \ 2...5 S~ch pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: ('dr'T S,.I"'~ <::r,. ) /Each sign or outline lighting (2) $ 63.00 $
~ature of signing supervisor: (- -:/ .-----; / Signal circuit or a limited-energy panel,
, "/' alteration, or extension (2) $ 63.00 $
d~ ~r \jri,( Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ .7.S (
(Minimum Permit Fee $58.00)
(8) Enter 12% surcharge (.12 x [Aj) $ Z8011:5
#,;fJ (C) Technnlogy Fee (5% of[A]) $ J{~
TOTAL rees aod surcharges (A throogh C): $.",. 8
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440-2584.) (9/08/COM)
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SPRINGFIELD
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OREGON
TRANSACTION RECEIPT
811-SPR2010-00489
5744 Peridot WAY
CITY OF SPRINGFIELD
225 Fifth Sl
Springfield,OR 97477
541-726-3753
www.cLspringfield.or.us
permitcenler@ci.springfield.or.us
I{ECEIPT NO: 2010000927 RECORD NO: 81 I-SPR201O-00489 DATE: 11/29/2010
I:Qjg~CRIF!TIQ~~ -t'"J~L_;l;;;>;?_i~~~ilfrll;; :':;~lli:'i;;;;:>- -J,1Z"-l\!;;CQU~"f~G_QQE~ }i'.;'~;,; ~;'-Il\J,iQ.!.l_NTDQ E . .. :j,t~-L;-E-'l
Residence wiring 1,000 sq It. or less 224-00000-426102 $134.00
Each added 5()1!.~.9; ft. or portion 224-00000-426102 $100.00
~,,~I Oregon Surcharge (12% 01 applicable lees) ______~B21-00~-215004 $28.08
Technology lee (5% 01 permit total) ______.__._100:~:~25605 $11.70
TOTAL DUE: $273.78
h..-;e~YIVi-'~.NTG.TjJ?E;' -P~Y6R' ::';CASHIER DBOW'SBYf"i-'(;QMMEr-i"f.S~ - _, ' 'AIViOiJNT PAID' } .",.,<,-, .J
Check
2215
Notdurft Shaun
$273.78
$273.78