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HomeMy WebLinkAboutPermit Electrical 2010-11-24 Electrical Permit Application 1< ."- . .. ~-_",'_.&r: ~~" ." ~""." J.;'''''";;;~: _.~.".. . (Jrr:y."()F":SPRINGFm~D 'OREtiQN' ': $- -. co," > ~; :"'~:" ~ . ~ I, ;~,.. " " "" . " . "" "....~,.. ':."",' t.::'''' 'DE.PARrMENr..USEONl V:, .:,' "" ._._'u.oc _.._ . . , ..- . .-...$1t. 225 Fifth St....t.Springfield. OR 97477tPH(541)726-3753',~1r.'.(~V7a~;.3~82hhl.L FXPIRE IF THE V';CRK f\UTHOP.l~ED UNDER THIS Date: : ..,eL.;:-r IS ~'0T COMr.1"~'CED OR IS This permit is issued uuder OAR 918-309-0000ip~~l'tiil~~f~'1l;,it~a~~'rir~';le~P"e'}.;:ft~1~Elre if work is not started within 180 days of issuance or if work is suspeuded for 180 days. 's'!"il!oCAI..:GOVERNMENr;4APPROYAI.:~\f~"~~.. "J Zoning approval verified? 0 Yes 0 No ," '=€f~CArEGORY'.'OF"CONSrRUCJ"ION;L.. 5 Name: ~ City: Phone: E.mail: This installation is being made 0," residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(i). Signing supervisor's license no.: ~d-S'75 Print name of signing supervisor: B~{i~i"-L.j- S2-e{r4 Signature of signing supervisor: ?\~o-~e.. . ~\\ b~G...~ 0--\ .~~3).\.o--:-'\~~\~S::l. eX. \ \1.-\ \=0, i'( -O~,'~. W'\.- . ~(I. K:l hOu < \\J.. . lu -. _' _~' .-. . .. tH:S ptRMITSHALL EXPhiE'!F THE WOR WTHOr:;;ZED UNDER. THIS PERiViIT IS NO CO~,~~';ENCED OR IS .l\6AI~DlJNEIJ FOR 440.2584.)(9108/COM;,'.IY ;SQ DAY PERIOD. ~ :.~ "'" .SCHEOUI:E~$" "';"'-"":i,'';'" .': r~.i~,. "'i0",';>':P;~-:,."","_ ,~-,"'<:~-~'-<:':-"'-, J:Y0'i^~r -::<-::::-::~ :- ,"'CoSt.. '~:', Total' ~N~mber_~fl?SP_~C:~2D~_~~r:0~~-!;t~~ g~: /.;+oLell>, j~~ 3__"';COS~';'":: Residential, per unit, service included: 1,000 sq. ft. or less (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) R $ 81.00 $ C/IR,' - 20 I 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 yolts (2) I $469.00 $ 1((:,(1.' 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 section above Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit 11641 $ 6.00 I $%y' b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 55.00 $ Each additional branch circuit $ 6.00 $ Miscellaneous fees: service or feeder not 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 $ ~~,~ .,' ..:"~:'rC;7JAj:iF'jjCANT~USE' ,._~:> " (A) Enter subtotal of above fe-es (2,(0/,' (Minimum Permit Fee $58.00) . (B) EnterW2llb'Stifdb,arge1(li!;i?go[;:\'])W requires yo I to f$lIoiZ-5~.' ~ I~(C) Tecl[Jl?li?~FPfl!2~'6! (:gJ) ~..~~~ ~~~~tr. r-!{ ;i~c~t~ k-.'i.o5 I" TOT AE1fei;$ .n<! ~gr~~'rg...!((~-ctii;'o~gii.s;h'; u"~~~- r?,Ihl/ .. CO I pes 01 me rules oy calling the center (Note. the telephone number for the Oregon Utility Notification Center is 1-800-332-2344). www.ci.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00101 2800 GATEWAY ST CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541.726.3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2010000914 RECORD NO: 811-SPR2010-00101 DATE: 11/24/2010 I .,~ 'l~' ,\(."li;;";:$:;:.<t.V" . ., ". ',,"."W0il1FFi'mm.ltlilH1'j'ftfS"':-' 1 " . "~ ."%;..".'''.'''''.';''''''''..''1'''.....'.. '''W.. .'-" ' . "al; """"" . , ".,.....;....,.,..".'.~'i...'...4i '( DESCRIPmIONij~ ,) j, 1, I' .",j U:;1;lNnij.!j)::F:;;i;):;/:;;;tj~:~';'.,,:, ~,';:~;;)iij:Ui!\l;qjjmHtlmWi'~'Cd-G~OJ~U:fr~G~QQ,E;;;:;;;.!rtf!L;;;::;>,;..~,:,.~t;:.'AM~QUNT'DtlE''';n'; ..... Services over 1,000 amps or volts 224-00000-426102 $469.00 Services 200 amps or less 224-00000-426102 $648.00 Branch circuits with service or feeder each circuit 224-00000-426102 $984.00 Permit Fee Adjustment - Tech Fee 100-00000-425605 $105.05 Permit Fee Adjustment - State Surcharge .821-00000-215004 $252.12 TOTAL DUE: $2,458.17 P YOR ''''II'''' ,'" ..,.......,.~..., ' .. ./...'....,.. ''','.'.. ..,......,."". "'.' 'iJ"iil1;I1-,"''1--\%\ffi''''';Jj''~' . 'lV'.I., A'M' O. .."U"..N"T,'..'P.....Ai..'I.D.;..jIJ.',."I',I'I'1:",.. 'I,..'.',....'...:,:...1..,."...!.!. t'14 . ,A",' ',;;:Hl'i!l1i:cAS'8IE.R:'l..fIOPP,ER ''';':;'~i~i'COMM~~I[$ijUU;!i;!:l/n';;;i;:;i~i:0" ;;,'''" "I,' .i~,w,. .;'. k, ;'.;-] " '.1 I, PAyMENT TYPE Credit Card Bear Electric $2,458.17 $2,458.17