HomeMy WebLinkAboutPermit Electrical 2011-2-18
Electrieal Permit AJ!plication
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115 Fifth Strft..Sprinlfield. OR 97477. PH(54I)726-J753. F A.'X(Stt )726-3689
~
, ,DEPARTMENT-USE ONLY:
,,- "'", < ',' ,-",'
Permit no~<220 \ \ - 'l.
Date 2--I~- '20\.. \
q
This permit is issued under OAR 9J8-309-0000. Permits arc nontranderable. Pennib expire if work is not started ",'ithin 180
days ofissuanu or if work is suspended for 180 days.
. '>LOCAlGOVERNMENTA~~ROVAL . , - , ' , .' FEE 'SCHEDULE. -;' . '; '. '.
" . . . , '..-
Zoning approval verified? DYes DNo/- .' Cost Total
N~nnbe~ ~rinS~c.ti~ns IK:.r-~~~~-~ ).. ~Qtf ' . ea. cost ,".
: ,c. "CATEGORY OFCONSTRUCTIOIIV""C:.. ' .
I 0 Government -1i11ConIDlercial Residential, per unit, sprvice included:
o Residential
JOB SITE INFORMATION ,AND LOCATION~, ,-:< Looo sq, fL orkss (4) $134.00 $
Job site address: I C eoO G -::::s\ Each additional 500 sq, fL or portion $ 25.00 $
thereof
Citi; "1'i\l1 ~ ,yyJ, ~;Dd State{'W ZIP:Cf711'J-'" Limited energy (2) $ 32.00 $
Subdivi~on: 1 f'] i ",' ~f) . I Lot no,OA.l.oOT Each manufactured homc or modular $ 63.00 $
"DtSCRI~IONOF WORK, " " , dwel1ing service OJ feeder (2)
'. " .
'1).. V CJ-..l'U-- J j "17 ~/ o..c..-/ Services or feedf'rs: installation, alteratio1J, relocation
SYllJ-.~ O'/Y\C ~\ 200 amps or less (2) $ 81.00 $
',',."PR( rPERTY.' OWNER " ,',. "-," 20 t to 400 :unps (2) $ 95.00 $
Name:\,<\C'\.( r::.'>" ~ T, -','0 J..n ... -.;QE..J-.- 40 I to 600 amps (2) $158.00 $
Address: X. &- --::::::;l 60 I to 1.000 :unps (2) $205.00 $
.
~"~ ~~ no 0 ct SlatO/ ZIP:!l '-fTi Over 1,000 amps or volts (2) ~,OO $
Phone: r , ~ I Fax: - . Reconnect only (2) $ 63.00 $
E-mail: I Temporary ~rviCfS or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps OT less (2) $ 63.00 $
0\':000 'by me or a member of nw immediate familv, This 201 to 400 amps (2) $ 87.00 S
property' is nol intended for sale: exchange, lease, or rent. OAR
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 \'olts, see services or feeders section above
CONTRACTOR INSTALLATION' :',". :. Branch circuits: new. alteration. e;xJension per panel
Business name: \~f_ L.I Il - I. ; , -::-r~, 3. fee for bronch circuits with purcha<re of a service or feeder fee:
Address: 2..1<51 '7H--,(). I " 1 Each branch circuit I $ 6.00 $
City: <' 7(Ortf I State: 0 V ZIP Q-7<J..11 b. Fee for branch circuits: without purchase of a service or feeder fee:
Phone: ~l '::1"''=>- 1. ~'l Fax:'StH . i4~d ~S5 First branch circuil (2) / $ 55.00 $ <:S 5,
i E,mail: ~p,(;l) ..}I< "'EI ~ ~.(..Ol'V) Each additional branch circuit $ 6.00 $
CC13 license no.: 4'5 I 2..'1 BCD license no.: 2.0'2..1,(.. Miscelbneous fpes: service or feeder not ;~cluded
Signing supervisor's liCense no.: '-\-'il'~S i Each pump Of irrigation circle (2) S 63.00 $
Print ruune of signing supcrvisor:.,jn.l!u-D I J t..." If JI f\ r , Each sign or outline lighting (2) S 63.00 S
Signature of signing supervisor: , - VI Signall.-ircuit or a limited-energy panel, S 63.00
alteration. or extension (2) S
l.J ~~~ Each additional inspection: (I) $58.00 $
~~~,\\ i,"', .'o',; '" " "APPLlCANT}USE ., / :..' ~
(A) Enter subtotal . ~es~ $ S'{.
TTENTION: Oregon law requires you.IO !J: ~ (Minimum ~~SS8.(0)
How rules adopted by the Oregon UtJlily (8) Entl.--r 12% surchargE"f.12 x (AD $ '7 ;,0
otitication Center. Those rUlle~:~ ~~~.tg~;~ ~ ~ (C) Technology Fee (5% of IAn $ (p. Cp
OAR 952-001-0010 throug1 ' TOTAL fees and surcharges (A through C): $ (/'OJ >(/?
090. You may obtain COPI~S at the rules by
au
A
to
N
in
o calling the center, (Note. the tele~hone
r tor the Oregon Utility Notltlcatlon
1l1\~-'C1j'h~e?~& 1_800,332-2344).
NOTWE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
Sp.R1NG FIE~
.~
' .r/!JfJ .
x'&: OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541-726.3753
www.ci.springfield.or.us
811-SPR2011-00267
1460 G ST
permitcenter@cLspringfield.or.us
RECEIPT NO: 2011000314 RECORD NO: 811-SPR2011-00267
rDESCRIe.iION-~~>~:tEj''':,< VO$~;!<0+*:,.:~t~'Y3.~::~_>,'f..\_' '<; ~{'j:(C.b,O.ONt~c'c5[iE~:~~~>"'Z-'~~-
Balance of Minimum Electrical Permit Fees 224-00000-426102
Branch circuits without service or feeder -1st circuit 224-00000A26102
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology fee (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: 02/18/2011
""p , AMOUNtD(jE~.~-""~_:~!.J
3.00
55.00
6.96
2.90
67.86
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EJ1~Y-Ml'!'lJ:IYEE??"" :.RA YOR.~._,CASHIER: NMACHADO,:.' ":: '.
Credit Card JK GUCKENBERGER ELECTRIC
005190 INC
- C(jM-MEiHS.~ .::. _,'..' .. '-,~ '~ '" ;:.':";;All.illlNT ",AID-:.. ., 'c
67.86
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TOTAL PAID:
67.86