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HomeMy WebLinkAboutPermit Electrical 2011-1-19 ,", i J Electrical Permit Application I @ITi)f (IDIJ~(ffirmm,@~ 225 Fifth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726-3689 DEPARTMENT USE ONLY I.~ Date: Permit no.: . This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire jfwork is not started within 180 days ofissnance or if work is suspended for 180 days. ,. ~. subtotal of abovefees ~ll~rl~EE~MIT SHALL EXPIRE IF THE WO~RK ~$' n urn Permit Fee $58.00) \UTHORIZED UNDER THIS PERMIT IS NOT _V1-st ~ r 12% surcharge (.12 x [A]) C;Oil~MENCED OR IS ABANDONED FOR -,. \. ~\jv b~ logy Fee (5% of [A]) ,\NY i 80 DAY PERIOD. ~~fi ~. ."~~~ ~fee,;d surcharges (A through C): 440-25&4-1 (9/08/COM) <q oN ~ . & ~ ,,~ LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION D Residential D Government D Commercial JOB SITE INFORMATION AND LOCATION Ci . Phone: E-mail: This installation is being made on residential or fann 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(1). Signature: CONTRACTOR INSTALLATION " ZIP,c17 <I 0 I ()1> . Cc>w'-- BCD license no.: ;)O-5~ 1C- Signing supervisor's license no.: c....( ,?,l.f Print name of signing supervisor: IVtt elf . (Pow! I.! Signature of signing supervisor: Number of inspections per item () Total cost $134.00 $ $ 25.00 $ $ 32.00 $ $ 63.00 $ Residential, per unit, service included: 1,000 sq. ft. or less (4) Each additional 500 sq. ft. or portion thereof Limited energy (2) Each manufactured home or modular 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 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 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit rP $ :tr. . . TRANSACTION RECEIPT 811-SPR2010-00726 4824 HIGH BANKS RD www.ci.springfield.or.us CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726~3753 RECEIPT NO: 2011000118 RECORD NO: 811-SPR2010-00726 permitcenter@ci.springfield.or,us ~bESC Rf~tI6N"; ::':~'<"J;:7~:'".;~1~,'~'i~;;".tJ::'~~~)Li:0; ',2 '~;, _~', :c:;;i'pJ>~~~~~~,:; ';~Acc:(iONj.lC_b[)E~iWt'"o i' .:t~,~;;,~; Branch circuits with service or feeder each circuit 224-00000-426102 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 Technology fee (5% of permit total) 100-00000-425605 TOTAL DUE: "~~'.' ~. .... . ." ....'C''fi':.....-.....'''...:..., "..,--.,,-,.,,-, .' '" .l. .' ,.' ......- ~ ~ ",-..c," --'... " 'A'-"'; "j.",J> %F:.' - ,~.~ ...---"..~-m:., ~..,. ~':,..C.-:':..:', - L::F'A YMENT TYP!;__,:;:C- E~YORY;;-- ~_tpASHIER: '!'!'~~E2:,,"~,,--C_OMMENIS ::7,n-:l;';l;;.-!c~..;::-, Credit Card GMD ELECTRIC/MICHAEL K. GOWINGS 079934 TOTAL PAID: DATE: 01/19/2011 : 'if-'AMOUNTcDlIE-':')':"i,,_'d , 108.00 12.96 5.40 126.36 . AMOUNT,PAID': :;.~.;. 'W $126.36 $126.36