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HomeMy WebLinkAboutPermit Electrical 2010-12-21 Electrital Permit Application . . 225 Fifth Street. Springfield, OR 97477.PH(541)726-3753tFAX(541)726-3689 SPRINGFIELD ~-~ ., ~~.. '""""":~ ", '.DE~~RTMENT U~EONL y ~!~n'f.:OtO-O c:) crLf 8 Dale: IZ~?(-ID This permit is iss'ued 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. .>, ";l!OCAU90"ERNMENT'MI"ROVAG;:;,;,.gi;;~Y"n;' Zoning approval verified? 0 Yes 0 No '!;;.;;;:"i:':.i:CATEGORY3C5F,~c:ONSTRUCTION',.1!.. '." D Residential D Government D Commercial ~J(~~1l0B~SITE;'iINFQRNlATIONfl'AND?;;IZ()-CA;r,I()N~~)li*.~'!i:ll (.J 0;:11"",11- S . City: C 7<: ZIP: ci 7'17 '7 Reference:' 70'S Z. 7:3 ( Taxlot.: 00 C . 'OESCRIPTIONi..'OF'WORK,;j;"_\::;-,";,\,,V::;,/''" .D.'ie, <'5,5 Iter.;.)- j~.rJl'" ;[;,,51:)/ ,In , Name: ZIP C; 747? This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479 .S40( I) and 4 79i/S60,~1 ).~__ /.! 1J.-;?;, Signature: "':J:~/ 'LA t4' / ,.CONTRACTOR INSTALLATION Business name: C?l"'I'{M Address: -- City: Phone: E-mail: CCB license no.: Signing supervisor's r ~f\T;19~;~ . ~ .~.. .-......... IU C Print name of signi sUpl!tvisot:s adopt~d bv thp. rAn I Iti!: OllT/Cellon C t T ~ - '''. Signature of signin&1 ulJer.\(i~or,; f1 en ;~. ~ose r~le~ ~~e set for h -. II V~~l VM ;) - 1.. 0090,. You may obtain copies of the rules b calling the center, (Note: the telephone y number for the Oregon Utility Notification Center IS 1-800-332-2344). NOTICE: ~\J ~~~~~. ;~~H6ERM'T SHALL EXPIRE IF THE WORK W COM RIZED UNDER THIS PERMIT IS NOT tJ' MENCED OR IS ABANDONED FOR AhlV 1 ~f1 "^'i.DE 440-2584-) (9/08/C>:OlvU) RIOD. ~~':~':~;;:'{~1~B,f~:~7!11;;;t~30:~~'117:,EE'~SC.HE.[j,l!JL!,E:\f~1f*F.'~~.12~i~.:[~J.R ,N u~~er Ofi~fi~~~ii~ri{p~rit~~,(S,'.;-IQfY. . Cost. '" 'Totar ',," ..'" ...<, """"'''"'''',''''''1 "". ',";",'; ,"_<, ),1_ :~~'i'. , I. cost. " Residential, per unit, service included: 1,000 sq. ft. or1oss(4) $134,00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158,00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, alteration, relocation 200 amps or less (2) $ 63.00 $ 201 to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders sectj~n above Branch circuits: new, alteration, extension per panel a, Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 6.00 $ b. Fee for branch circuits without purch~se of a service or feeder fee: First branch circuit (2) I $ 55.00 $ . ~ Each additional branch circuit I $ 6.00 $ h Miscellaneous fees: service or feeder no! included Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63,00 $ Signal circuit or a limited-energy panel, $ 63,00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ ;~::K"{$W!F<:.J'*t\T-'i:r:W~,,;T1Ji;';d?;fA'RPi1iCA't\jt~,US-E\:~~~{IN::-'p,~~,~,*~,;,,:;>.:t.~/"~,:. /j:~k~4."J~;}':;~~:r,"';;;i'tr'\:5i'l-;" ",.;; :", .. 00" 'ff'f'. o._,t~s"JtJ~.L);'(:~;i;-i~<t~~":.{{ffi:[f-i'j'i:::-"'.':'~.' (A) Enter subtotal of above fees {,( (Minimum Permit Fee $58,00) $ (8) Enter 12% surcharge (.12 x [A]) $ 77Z (C) Technology Fee (5% of [A]) $ 30,) TOTAL fees and surcharges (A through C): $7/77 , t SPA~N~=L~ ~~ ~OKEGON www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00948 820 W QUINAL T ST CITY OF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 permitcenter@ci,springfield.or.us RECEIPT NO: 2010001108 RECORD NO: 81 I-SPR2010-00948 DATE: 12/21/2010 State of Oregon Surcharge (12% of applicable fees) TechnologY fee (5% of permit total) C4/'/ -""".'\;,-,"'C_COJJ}j:r~C-')DE -'-/;j;.;i ii- AM.ctUllIJ>.UE:, 224-00000-426102 $6.00 224-00000-426102 $55.00 821-00000-215004 $7.32 100-00000-425605 $3.05 _..._----- TOTAL DUE: $71.37 ,PAYOR/ iCASHiER:DsCl\:t?ffis\'.j;.'(',,-:G:()lytllllE:J'iI$.Li: '. ':". ; 'r;1, ':;'-'1;' Al'i1buNTP~'-!b. .' .-.-:J I DESCRIP:J'f9N;~f.~;'i{::... .' .",,- Branch circuits with service or feeder each circuit Branch circuits without service or feeder ~ 1st circuit D:..PAVMENJ;TVPE ":""", ,~--.-I ';",;;{w.........-J Credit Card 00632c michael harts field $71.37 $71.37 . .