HomeMy WebLinkAboutPermit Electrical 2011-1-5
01/03/11 MON 17:04 FAX 5417263669
225 Firtb Stn-t:t.SpriDJ:Ii.:I4, OR. 974".PH(!iIU)7:U-3753.FAX(S41)726-3689
CITY OF SPRINGFIELD
~001
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OEP~RTMENTUSE ONi. y.
S...INOPlI1:l..D;:"-:::c:,::4:."f.,
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Dale 1~05~2.01
This permit is isslled undOT OAR 9IlhJ09.{lOOO. Permits are nontransferable. Permits expire if work is not started within 180
day. onssnonee or if work is suspended for 180 days.
, "LaCAL..~()VERNJIII~T.APfflOVAb;.:;..' :'-"".
Zoning approval verified? 0 Ves 0 No
... ')CAtEGiJRY~Of-CQNSTRUCTIOI'l'>
Resideatial, per uDit, ,,"ie. in~ludcd:
1,000 sq. II. or less (4) $134.00 S
Each additional SOD sq, ft. or portion $ 25.00 S
thereof
Limited enerGY (2) S 32.00 $
Each manufacnJl'ed home or modular S 63.00 $
dwelling &eN;.. Or feeder (2)
ServiCe! or feeders: instal/ation, aJtC!r/2lion. reJOC<Jlion
200 amps 0' less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
Name 40 I to 600 amps (2) $158.00 $
Address: 601 to 1,000 amps (2) $205.00 $
ZIP: Over 1,000 wnps Or voltS (2) $469.00 S
R..onnect only (2) $ 63.00 $
E-mail:
CCB license no.: eIP -
Signing supcrvisor1s I;cense no.:
Print name of signing supervisor:
Signature of signing supervis
PosI-it" Fax Note 7671
TO
Phone a
Fax
'it".
',:
: "t::'~F ~G;'"..
~~
(j~
440-25!:!-J (9'.O~ICOM)'
. " ',.1'.'~:'
Temporary servica or feeders: inslRl/alicm, al(l:rafi01l. re./ocarion
200 impS or Ie.. (2) $ 63.00 S
201 to 400 omps (2) S 81.00 S
401 to 600 omps (2) S126.00 $
Over 600 amps or 1,000 vohs, see 5crvicc:s Dr feeders section above
Bnoth c:irtuits: ~ alt~fatlon. exltfuion pt!f panel
0.... Pee for branch circuits with puTthase of D service or feeder fee:
ElICh branch circuit
S
b. fee for branch circ:uilS'without purchase of a s~icc or feeder fee:
First branch circuit (2)
Each additional branch circuit
w
MiscellllDeoDl fees: s,""ice or Juder ~ol jl'/Cluded
ElICh pump or irrigation circle (2) S 63.00
Each sign or outline lighting (2) S 63.00
Signal circuit Dr alimitcd..cncrgy pllncl.
alt.c::rntion, or extension (2)
Eacb additional i..po<tion: (1) $59.00 $
f{i!;4~!Z';:V~;0,j':"S;1:{,Me"jc~t;,U$E\~,D"'A' ,'2~;
! (A) Enter .ublO1IlI of above fees
! (Minimum Permit Feo 558.00)
! (B) Enter 12% surchorgc (.12 x [All
(C) Technolol)Y Fee (5% of (All
TOTAL r... and surebarges (,I. through C):
$
S
S 63.00
S
$20~O
$ Z LIfo
$/ O~!:
sZ3Cj 1'5
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726~3753
www.ci.springfield.or.us
811-SPR2011-00025
3405 GATEWAY ST
permitcenler@ci,springfield,or.us
RECEIPT NO: 2011000040 RECORD NO: 811-SPR2011-00025 DATE: 01/05/2011
[DESCRIP-TION l , " ,,-, ',' ;:;~L_ ;;:, ,;,:}i;;:;;:.~~,-:.- \-,;;"AC:CO:UN:f~CODEA'::";:--" ,,;:L'~AMOUNTj)UE!L:. -; _,; ~-'1
Branch circuits with service or feeder each circuit 224-00000-426102 150.00
Branch circuits without service or feeder - 1st circuit 224-00000-426102 55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 24.60
Technolo~yfee (5%.of permit total) 100-00000-425605___ ____ _ 10.25
TOTAL DUE: 239.85
~~&I~'LE~J..:,UJl.gE;;;RAiQ.B' /;;;:CAsHIE~;;@ACHA[)9H-,--..Q_c:iiVIMEN:r.S--+L-- _0'" -' : AM.0.U!iLPAlD .; n,,' ':j
Check DOUGLAS L KARNES/SHILOH P.O. BOX 6097 $239.85
5397 ELECTRIC Salem Oregon 97304
_._----~.-~._-
TOTAL PAID:
$239.85
"