HomeMy WebLinkAboutPermit Electrical 2011-1-31
Ele~~ical Permit Application
~
225 Fifth Strcet+Springfield, OR 97477+ PH(541)126~3753. FAX(541)726-3689
DEPARTMENT USE ONLY
SPRINGFIELD -:S':.c.~",
L-,:~~'€i'~'tl!','~,':;,'~ >; Il- .s;:?e.,2011 - (JOI
~'~;:',..~,"t~!n''', 4M. .f,<'~.~' lItrfult no . .
'.:.t'ir~;:t!,- "A!! '" I Date !/3f /11
1 I
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within] 80
days of issuance or jf work is suspended for 180 days.
lOCAL GOVERNMENT APPROVAL
Zoning approval verified" 0 Yes D No
CATEGORY OF .CONSTRUCTION
o Residential I 0 Government 0 Commercial
<,." JOB SITE_INFORMATION, AND lOCATION
Job site addresp'/(). ') '5 (C'/;-A /7 I
CitvVl.JJ1 /i. ./ I State~ Z1p97-172i
Refere~c<l/ \I[['fl ~?")('D I Taxlott)\'/ {I }
DESCRIPTION OF WORK
I';A(I/l/r...l.- ) tJrlh,r l'u'Vla.I'I;
.. / 7
/1 '1= ROPERTY .OWNER V'
Name! ~ /1...1. /< ~7Lt1 "t; -.
AddressWJ < I':.::; .l -> 1/./ ~d
City: {n i-I' /~/ 'I Stat.7hJ
Phone/' {! - Fax:
-
ZIP 97v.7f
E-mail:
This installation 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 479560(1).
Signature:
CONTRACTOR INSTAllATION
Business name: kFar 11. _/. '.. r: "'.. )--r:;" /1(1
Address:tlG~ b.' 1I1l>,r( I......-LL /./)'
City: hl1J.{V'-f I State oIL I ZIP:17t./rA
Phone~ ~-7I14ilf tl Fax ~/ltrl-4L{{IC;
E-mail: /1't'(u- Ji^",,~L,: "- Lot ':l /,.- ~ (Ir-v--..
CCB license no.: /1,(79<<, BCD license no.:'/, //{f;;{A
Signing supervisor's license no.: 1/.1 i( (J <; "
Print name of signing supervisor: ~ (lt~ '~Ii/i;'",,~
Signature of signing supervisor:;?";?'", ,,)7 , A-,
[/. I ~ ~
NOTICE:
rHIS PERMIT SHALL EXPIRE IF THE WORK
IJn;~RI~EO UNDER THIS PERMIT IS NOT
, ^~f\LED OR IS ABANDONED FOR
. 1"\1 PERiOD. ~~
~~
\;l
440-2584-J (9/08/COM)
FEE SCHEDULE- .. ,
Number of inspections per item () Qty. Cost Total
ca. cost
Residential, per unit, service included:
1,000 sq. ft. or less (4) 5134.00 5 I
Each additional 500 sq. f1. or ponion I I 5 25.00 I 5 I
thereof I
Limited energy (2) I 5 32.00 I 5
Each manufactured home or modular 5 63.00 I 5
d\','elling service or feeder (2)
Services or feeders: installation, alteration. relocation
200 amps or less (2) S 81.00 $
20 I to 400 amps (2) 5 95.00 $
40 I to 600 amps (2) I 5158.00 5
60 I 10 1.000 amps (2) 5205.00 I 5
Over 1,000 amps or volts (2) I 5469.00 $ I
Reconnect only (2) 5 63.00 5
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 63.00 5
201 to 400 amps (2) I $ 87.00 I $
40110 600 amps (2) I 5126.00 I 5
Over 600 amps or 1,000 volts. see services or feeders section a~o\'e
Branch circuits: new, alteration, extension per panel
a. Fee "for branch circuits with purchase of a service or feeder fee:
Each branch circuit
T
5 6.00 5
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
/
$ 55.00 I 5
5 6.00 I $
Miscellaneous fees: service or feeder no! included
Each pump or irrigation circle (2) I S 63.00 S
Each sign or outline lighting (2) I S 63.00 I $
Signal circu!: 9\~J~rpHf~~ep"erg}~Pimeh Itl'J,t,P S 63.00 I 5
l''\1~~tiP\Obr.extenslO~ (;'), "'0 (VeOOII Utl!I~'1
f IEliiYh':l~dW~~fl~~~Pf,c1~~nj (1)I)eS are ';; lC\.nn 55800
~Pl\llvtl'" ',Mi ;601C'AF?,pL!lc'A~t'JJS:E_o - hv
~pW. &1n!;faoB\P@Pbj\~ethe't'~'I~phOne
dil.l1m!l'bine I!AAili ~ke6n';:YNotificatiOn
. QI-l\fl!h~J,Tr-:!"1';:;'sh~r$J:Q1-21~W~44).
(e) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through C):
5
$ 6r b-o
$ & .9cf;,.
S Z- Q':v
'f/77Xf.h
...
'32~~N:,.FIEL~
~~.
~OREGON
www.ci.springfietd.or.us
TRANSACTION RECEIPT
811-SPR2011-00146
205 S 54TH ST, SPACE 9
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541.726~3753
permitcenter@cLspringfield.or.us
RECORD NO: 811-SPR2011-00146 DATE: 01/31/2011
:,<..,,~,w;"ACcoOf'm::.bOE=~~:<\MQONtb(jE ,,'4","1
224-00000-426102 3.00
---- ~~-
224-00000-426102 55.00
- -~""'--'-"--"'-"'"-
821-00000-215004 6.96
-. &~~-~-_._._------
100-00000-425605 2.90
TOTAL DUE: 67,86
1:.riiR~:CI'iL~~fJRiEi;';';,;;-4f'RAY.9R:&t':CASHIER;'NMA'CHAi50!8,;-y."'-,,,,;i1:';--q,QJY(rJ(~t{[~,;,,,~~';;\;';- -~':'-"';';_'Yr:~AMOUNT'PAID.' ,
Credit Card BEAR MOUNTAIN ELECTRIC LLC 67.86
029400
RECEIPT NO: 2011000191
IOESCRIFi,TioN'c" .-,;;.,-- ';"';"~,-"
Balance of Minimum Electrical Permit Fees
Branch circuits without service or feeder - 1 st circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
;+.:~ >;*;"'; I
TOTAL PAID:
67.86