HomeMy WebLinkAboutPermit Electrical 2011-1-21
J Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
225 FiftbStreet+Springfield, OR 97477. PH(54 1)726-3753 + FAX(54 1)726-3689
~~
DEPARTMENT USE ONLY
Sftl ZOII- (.)0/ bl.(
Permit no.:
Date: /- Z I - II
This permit is issued under OAR 918.309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
D Residential I 0 Government I -gcommercial
JOB SITE INFORMATION AND LOCATION ,
Job site address: /,II g Y\(/t i l\ A 't' 2 i-
City: =-){ J(\ .~~ r ; I~ State: Or<. ZIP:
Reference: 170J:53 S:S:Z Taxlot.:04~C>C:
DESCRIPTION OF WORK
Ql)r\ r-nt-n. {- Te.1 V;-\m1' (l OJ. hI 0
\:'n< V\D j,( \ hll\" rt I J'\/J^
PROPERTY OWNE~1
Nf3'p c..O
Address: 21 Z. V\AAIN "f::.T
'St'r- ~ State: &<- ZIP: ~ 7'-r7-'
- - I Fax: - -
Name:
City:
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:
FEE SCHEDULE
Number of inspections per item ( ) Qty. Cost Total
... cost
Residential, per unit, service included:
1,000 sq.ll. 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) $ 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)
20 I to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INST ALLA TION Branch circnits: new. alteration, extension per panel
Business name: n('y')/'- d lI%1rl ~ /11 ..Y1J11PIA a. Fee for branch circuits with purchase ofa service or feeder fee:
Address: \~ I c;,. L rlV,-"-' \ , 0 + j Each branch circuit $ 6.00 $
City: '{ '1t\ '()Ot _~ -/ (rf State: r)~ ZIP:C(7lf7) b. Fee for branch circuits without purchase of a service or feeder fee:
Phone:~l...//- 7<J -IT ~ Fax: 5L//-iQ/-0?::J..17 Fiest b,aneh ci'euit (2) $ 55.00 $
E-mair.-t l' /7A (OJ()rYl' ) rin A'1 d ~ fl! fll1 IJ I J. " Each additional branch circuit $ 6.00 $
CCB license no.: ( .p dI-..2-/") I BCD license no.: I Miscellaneous fees: service or feeder not included
Signing supervisor's license no.: y '-I ()~ (_ t:H Each pump or irrigation circle (2)
Print name of signing supervisor: '-'-J-{fJ Oh J ~n 011 n t1 ' ~ outline lighting (2)
S. f" '..MA_()_ 'UI 'f'__ It " ~~torahmlted;energypanel,
Ignature 0 slgnmg supervlsor~ rl' I u~ alteration, or extension (2) .
Each additional inspection: (1)
ATTENTION: Oregon law requires you to ,,~;\M APPLICANT USE
follow rules adopted by the Oregon Utility \' ~~ (A) Enter subtotal of above rees
Nollficatlon Center. Those I ules are set forth "I:'\! (Minimum Permit Fee $58.00)
in OAR 952-001-0010 through Of\R 952-001- (B) Enter 12% surcharge (.12 x [A])
0090 You may obtain copies of the ruies by
caiiing the center. (Note:.lhe telephone N OTIC I: (C) Technology Fee (5% of[AD
number for the oregon Utility NotificatIon THIS PE ,TRJAIc fees and sn.rc~ar,g~s l~t",ro~~~,C):
Center is 1-800-332-2344 . '"'''' ., InLL LAI InL" II II: VVUJ1/\
AUTHORIZED UNDER THIS PERMIT IS NOT
440-2584.) (9108/COM) COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
$ 63.00 $
$ 63.00 $
I $ 63.00 $Le?:; ,0 0
$58.00 $
$1 i~,~()
$/. P)I 0
$ ?-'.ICh
$/~ 17 \
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~ORfGON
www.ci.springfietd.or.us
TRANSACTION RECEIPT
811-SPR2011-00104
212 MAIN ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541~726-3753
permitcenter@ci,springfield.or.us
State of Oregon Surcharge (12% of app!icable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-001 04 DATE: 01/21/2011
;~tr~e~qot:.:2~?l~~~,:~;~ACCo.UNT~CODE.;- i; F_'.i" ';e, _AMOUN:rJjUE~;,,;i:;,' ';,~,
224-00000-426102 63.00
821-00000-215004 7.56
~ ----
100-00000-425605 3.15
TOTAL DUE: 73,71
RECEIPT NO: 2011000144
IDESCRIf?TlbN;i:::;i";-;"...~,,;c:_ '00 "ft" . "
Data I Telecommunications
,:~J) AyORH;:?dAsHiER;':bBOw'CSBy-,~7',;1!1$,;~t"C'OMMENffst1~)ft!J;;';J:t:A-'~;; YS>:fS'4,
.._-_.. . '''-'' ~._.-_.,-"-,~~~ :!!
OMLlD & SWINNEY FIRE
PROTECTION & SECURITY INC
AMOUNT PAID' ,',- '".'
J",.w.h' "'~" ",,:'~,..':>~' ""1"--:..'.._-...:i
73.71
L~AYMENT TYPE~:;
Check
41254
TOTAL PAID:
73.71