HomeMy WebLinkAboutPermit Electrical 2010-12-28
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Electrical Perniit A
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225 I.ifth Street+Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
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DEPARTMENT USE ONLY
~)J;~: e.2010 -00
Date:Q ~t: 10
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This permit is issued under OAR 9 8- R 0 . ermlts af
days of issuance or if work is suspended for 180 days.
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LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Zoning approval verified? DYes DNo Number of ins pee dons. per item () Qty. Cost Total
ea. cost
CATEGORY OF CONSTRUCTION Residential, per unit, service included:
o Residential I 0 Government I fl'f'Commercial
1,000 sq. ft. or less (4)
JOB SITE INFORMATION AND LOCATION $134.00 $
Job site address: - Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City: ~~YI~111<../d I Slate: OXk I ZIP: <9'7<177 Limited energy (2) $ 32.00 $
Reference: \1b32/}h') I Tit .1'1' /I V"- Each manufactured home or modular
ax 0 0" $ 63.00 $
DESCRIPTION OF WORK dwelling _service or feeder (2)
H",JII~ C(T>fIn>/~ Services or feeders: instaflation, alteration, relocation
200 amps or less (2) $ 81.00 $
PROPERTY OWNE I<l 201 to 400 amps (2) $ 95.00 $
Name( I1f j~.Ji! 1 {'{)(1 J.1 . L ~,~. J 40110600 amps (2) $158.00 $
Addre..\-Aa n Jx' \ (l?i(00~ 601101,000 amps (2) $205.00 $
Citi 1 IJ..f r /) flu, I State: n I I ZIP! .r-1 ~I ./ Over 1,000 amps or volts (2) $469.00 $
Phone: 1\ I Fax: , Reconnect only (2) $ 63.00 $
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E-mail: ~ Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or fann property 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family. This 20 I to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR 40 I to 600 amps (2)
479.540(1) and 479.560(1). $126.00 $
Signature: -- Over 600 amps or 1,000 valls, see services or feeders section above
CONTRACTOR INSTALLATION Branch circuits: new, alteration. ex/ension per panel
Business name: Clolt'/Y,."...,C...../-AJ C.m4", 's a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 15<i~D SW /,f,dOc.r "_slv-... rei Each branch circuit I $ 6.00 I $
City: b.L ..<:_~.. ' r State: 6/Z<- I ZIP: tj71'7S b. Fee for branch circuits without purchase of a service or feeder fee:
Phone:f..~-5n- '1, iJ <I I Fax""...-f/_l1_ Id Z-.. First branch circuit (2) / $ 55.00 $5~~O
E-mail: Each additional branch circuit $ 6.00 $
CCB license no.: / 8 ~ 3z q I BCD license no.: 7, <(}<loG Miscellaneous fees: service orfeeder not included
Signing supervisor's license no.: ",.I, 5S Each pump or irrigation.circle (2) $ 63.00 $
Print name of signing supervisor: /'J?A,...,h;' ,l'Hf:/I?4...dd Each sign or outline lighting (2) $ '63.00 $
Signature of signing supervisor: M ~ -1- (j);o;y.l'v-r1--- Signal circuit or a limited~energy panel, t... $ 63.00 $ 1.;2'-. ""
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
ATTENTION: Oregon law requires you to ~(y (),:,O APPLICANT USE
(A) Enter subtotal of above fees
oHow rules adopted by the Oregon Utility \~:t (Minimum Permit Fee $58.00) $ /'8/. '"
otlflcatlon Center. Those rules are set forth
OAR 952-001-0010 through OAR 952-001- (8) Enter 12% surcharge (.12 x [AD $.:J',7~
90.. You may obtain copies of the rules by J\Y (C) Technology Fee (5% or [AD $ Q. ()~
calling the center. (Note; the telephone NOTICE: TOTAL rees and surcharges (A th"qygh C): $ ;1./1. 7
umber for the Oregon Utility Notitication.
- ~ IRE ,~ I MJ: VVV' '"
nontransferable. Permits expire if work is not started within 180
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n
Center IS 1 800-33,,-2344).
440-2584-J (9108/COM)
THIS PERMIT SHALL EXP OT
AUTHORIZED UNDER THIS PERMIT IS N
COMMENCED OR IS ABANDONED FOR
f,NY 180 DAY PERIOD.
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Wlt~
. t;4:,\ OREGON
WWIN. ci. springfield ,or. us
TRANSACTION -RECEIPT
811-SPR2010-00984
2800 GATEWAY ST
CITY OF SPRINGFIELD
225 Fifth SI
Springfield, OR 97477
541.726.3753
permilcenter@ci.springfield.or.us
RECEIPT NO: 2010001158
RECORD NO: 8 I I -SPR20 10-00984
DATE: 12/28/2010
t.DESCRIPJION.. :,'. - J;tE,g:!~!'i'1"~;--*._-':.0-.~~-:-:?4li'l4t~4c-c.o_lJN:T~C:OOE~:~'::"'t*::;~;f';'JyI_0.utD".Jl.UJ::~. .:' "1
Branch circuiIs wiIhout service or feeder - 1st circuit 224-00000-426102 $55.00
Signal circuiI(s) or limited-energy panel, alteration, or extension 224-00000-426102 $126.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $21.72
Technology fee (5% of permit total) 100-00000-425605 $9.05
TOTAL DUE: $211.77
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Check
36547
Environmental Control Corp
. $211.77
$211.77