HomeMy WebLinkAboutPermit Building 2011-1-31
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Electrical Permit A
225 j.iftb Stl"tet.Spdngfield, OR 97471.PH(541)726-3753. FAX(S41)726-3689
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Pennit no.:
Date: ( - -:) J - II
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This' permit is issued' under OAR 918-309-0000. Permits are nontrdnsferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days. .
E-mail:
This insta1lation 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
479.540(1) and 479.560(1). , f
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Signature: .- f 1- tJ
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Business n.me' _ .~. ~. ~lvlll H
Address: 5480VS.w:'pV" , ,,,,,, I ~~ i':?, ,I'll\.-.
City: t,:ORVALLlS~ <BRWON 97$:tIP:
Phone:s:--=lI-iftJ PJ3C, I Fax: - ~S..; J'J3---
E-mail:
CCB license no.: Iff" 711 BCD license no.: ;;;!. C/-~~./
Signing supervisor's license no.: ..7 / f :::z S
Print name of sigrung supervisor: -r Q \-\-1' ~ b I . ~\
Signature of signing supervisor:
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Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or pnrtion
thereof
$134.00
$ 25.00
,;;;~;;;.;;gl;~;2lCO.cAIl.'IG()VERNMEN1i~ARRROVAIt:~:;"r,i;;J:ll\,i
Zoning '!Pproval verified? 0 YoS 0 No . '.
~~~tJ;CATEGORY,\Ol:i'CONS1"ROCTI(jN~i\ft"\t);':.~~;~
III Residential I 0 Government I 0 Commercial
If;~.,,~t~J08j''SITE~INI;ORMA'liION;)ANDnIlOCATIONii'~0"li;~~
Job site address: /~Sl Cc;+\ol\-woo-,.I, the
City: c:,,,,...~f\<t~,'<" U I State: fSk ZIP: '1T'/11
Reference: lrb J "2.-7"3 J I Taxlot.: C>S7c).) Each rnanufactured home 0' modular
,?...,,';"ill."';.',,',;~i;\!.DcSCR.ln... ,.10, N"O' c;AW O''''K..,W'L;'')Q')''';'''';'''~'''.'-;.' dwellmg servIce or feeder (2)
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fk\ lOM(.' 0 A II . ' ~. W :. . . +, Services or feeders: inslnl/a/ian, ai/era/ion. relocation
'-Y I , . 200 amps or less (2) $ 81.00
~~~,?(;,tM4i%;~~~}:Y~r;r;~r#.J;p.R.bREFfTL'(~:(jWNERiS't;:;t~Y~{aw~?J~ifji:;:_ff~4 201 to 400 amps (2) $ 95.00
Name: II Vo 1\ "p , S~ \ ~. 01 1 401 to 600 amps (2) $158.00
Address: I b 5'1 r" J..i - ."l'\,_ . ( 601 to 1,000 amps (2) $205.00
City: c:::.-:pr=-''t:, I State: CNL... ZIP: '?7ct77 Over 1,000 amps or volts (2) $469.00
Phone: _ _ I Fax: _ _ Reconnect nnly (2) $ 63.00
Limited energy (2)
$ 32.00
$ 63.00
$
$
$
$
$
$
$
$
$
$
Tei:nporary serVices or feeders: installation, alteration, relocation
200 amps orless (2) $ 63.00 $
20t 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 fur brnncb circuits with purchase of a service or feeder fee:
Each branch circuit
1
$ 6.00
b. Fee for branch circuits without purchase of a service or feeder fee:
$
First branch circuit (2)
Elli::h additional branch circuit
j
.:3
$ 55.00
$ 6.00
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (t) $58.00 $
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ATTENTION: Oregon law requires you to \~JV<.Y , .~.' I"
(A) Enter:siIbtotal of above fees
fo.llow.rules ado. pt.ed by the Orego. nUtility. . ~ . ., $ .",:;> -
. ,~(Minimum Permit Fee $58.(0) / ~
Notiiiqation Center. Those rules are set forth ' \,; .
in_OAB 952:.0.01 ~DD1 .0 through OAR 952..0.01. \l . (8) Enter 12% surcharge (.12 x [A]) $ J' ~ ' ,..
.0.09.0: You may obtain copies of the rules by f} (C) Technology Fee (5%0f[A]) " . $. 3~ .-
::-calling the center. (Note: the telephone _ _ . c::
number for the Oregon Utility Notification NOTICE: TOTAL fees and surcharges (A throngh C): ~y , ~
Center is 1.8.0.0.332'2344). THIS PERMIT SHALL EXPIRE IFTHE WORK ~8S L.[l
440-2584.) (9/08/COM) AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
'.-'r
Miscellancou$ fees: service or feeder not included
$ 63.00
$ 63.00
$ 63.00
ANY 180 DAY PERIOD.
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$
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www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00147
1651 COTTONWOOD AVE
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000193 RECORD NO: 811-SPR2011-00147 DATE: 01/31/2011
rDESCRI[TI0N<-,,-y~-...~.iJ- ;~::~,,~,. ';:-''-', :-;;;~fF~;B'.r'lb::;;::;lf2;Ac.COUN:f~CQOE' /",.", P';;""'~i"'AMO:UN'fiDUE.:i";:'~;7.,,>t
Branch circuits with service or feeder each circuit 224~OOOOO-426102 18.00
Branch circuits without service or feeder -1st circuit 224-00000-426102 55.00
State of Oregon Surcharg~ (12% of applicable fees) 821-00000-215004 8.76
__2.echnolo~y fee (5% of permit total) 100-00000-425605 3.65
TOTAL DUE: 85.41
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85.41
!"..PAYMENT:rYPE' F.:
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Check
25438
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RG SMITH ELECTRICAL
CONTRACTING INC
TOTAL PAID:
85.41