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HomeMy WebLinkAboutPermit Electrical 2011-2-15 Electrical Permit Application CITY OF SPRINGFIELD, OREGON 225 Fiftb Streett Springfield, OR 97477. PH(54 J )726-3753 oFAX(541 )726-3689 ~~ Penn it no.: Date: -/ This permit is,lssued under OAR 918-309-0000.Perlnits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. ~. Each pump or irrigation circle (2) -<\\~ 'I". "b1sach sign or outline lighting (2) <_ \" .~'0 '.<l Signal circuit or a limited-energy panei, '?--"'" '~o..\"" < ~\ alteration, or extension (2) ,,-\,.\" ~~~\S :(j~~\) Each additiooal inspectioo: (l~ <..' ~'k <,~ ,,-~'v . i\\\"'V' ~ '. ' ~\;v ,;>-'QI" APPLICANT USE ~ro. ""\.S~. ~~~I v./.~ _9>~~'J (A) Enter subtotal of above fees , ,('" ~ ., (Mhtimum Permit Fee $5l1.00) , \." \,\V <,'" .'V , ....\ \. ~,\." . . ,,\1/'\ '(;(\ ~" (B) Enter 12% surcharge (.] 2 x [A]) ':'.~ '\. \ ~ (C)Technology Fee (5%of[AJ) \y'\:i TOTAL fees and surchllJ"ges:{;\ through C): " o', LOCAL GOVERNMENT APPROVAL Zoning approval verified? DYes D No CATEGORY OF CONSTRUCTION ~ Residential I D Government I D Commercial , JOB SITE INFORMATION AND LOCATION Job site address: '};).o ") '5 T1'- t.IT City: S,o12.1 ~ 'if. P-/ e L r5 State: (')f2- I ZIP: q 7lf77 Reference: IfJfr'i lirl40(){o()',"', Taxlol.: l7-o3'~lH' ' DESCRIPTION OF WORK f<."nP..fl Ir::n A.1<P Mtm-,')L M/4.IJJ uY;l..o,\<\,w# - ' s..,-jl..,/t( ~ f PROPERTY OWNER . Name:""-T1+fZ.t<-€fD 1- v/;/,.A ,I,~.,) t; t6~N Address: ,(;).D 5 ."> fi2 ~e "T City: Sf fl.)~" c, LI f) State: '1'Jt2- I ZIP: Cf 71./ 7 7 Phone:S'f~ 7Y" - OG, 8 2;. I Fax: - - E-mail: ItA",',,<- "'- ~ /"16"1-.-.... 'I.&~IA/\ 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.,~or sale, exchange, lease, or rent. OAR 479.540(1) and 479.560fl).', './ Signature: ~AM.A G c:---- . ,'01} \~.,' ~ONTRACTOR INS ~,,-~~ Business n~me: .nnOf- \~~\'{Ie _~ e,\e :~~:.Q()\~. Address: _.\"':\O~'n~~~\0~~o'i>e \,,;:,, Op..~; \I}\e'i>^~' City: ~,',,~ tl}\e: 6ef-\~~\~ ~~~\e'i> o~ \e' ,,\of- Phone: ~~~~\~\~~~'Z..o\J_~ O'OW' :. 'X\\'f ~.o';. E-mail: \f- O~",<o~~; ce~"O\e~?~.',)'2>'2:.t-" CCB Iicens~vnca'\\~;.t \01 ~\~~ \'i>I"B'CD license no.: Signing supe~ci~\s I~ no.: Print name of signing superv,isor: Signature of signing supervisor: 440-2584-J (9/08fCOM) "t PEe SCHEDULE Number ofinspectionfj per item () Qty. Cost Total.. ea. cost Residential, per unit, service included: 1,000 sq, ft, or less (4) $134.00 $' Each additional 500 sq. ft. or porti01 $ 25.00 $ thereof LiJDill:d.,energy (2) $ 32.00 $ b8cmnanufactured home or modular $ 63,00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) I $ 81.00 $ St 201 to 400 amps (2) $ ~5.00 1$ 40] to 600 amps (2) $158.00 $ 60] to 1,000 amps (2) $205.00 $ Over ],000 amps or volts (2~ $469,00. $ Reconnect only (2) $ 63.00 $ Temporary services or feeders: installation, altdfption, relocation 200 amps or less (2) 4. $ 63.00 $~ 20] to 400 amps (2) r $ 87.00 $ 40] to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: new, alteration, extension pe~ panel a Fee for branch circuits with purchase of a service or feeder fei: Each branch circuit I li:J 6.00 I $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ 6.00 $ $ Miscellaneous fees: service or feeder not included $ 63.00 $ 63.00 $ $ $ $ $ 63.00 $58.00 $~\~ $ q:'[t: $ l\.:flD $(j A ""11 \. ., www.ci.springfield.or.us TRANSACTION RECEIPT 811-5PR2011-00238 112055T GITYOF SPRINGFIELD 225 Fifth St Springfield, OR 97477 541-726-3753 permitcenter@ci.springfield.or.us RECEIPT NO: 2011000289 RECORD NO: 811-SPR2011-00238 DATE: 02/15/2011 rDESCRIP..Tlo^N:;;.:,::t;.' ;:", "";~c:'0of,o''\-\>(;:.:::j.:;:J.:::f;~'nrc''ACC0(JfII:f~CODE' :::/ :~ "",,", .'.'Aivl6uNTC15UE '0'>'" ".1 Services 200 amps or less 224.00000.426102 81.00 State of Oregon Surcharge (12% of applicable fees) 821-00000.215004 9.72 Technology fee (5% of permit total) 100.00000.425605 4.05 TOTAL DUE: 94.77 :~';~""PAY'"'O-R ~;.''CASHIER;' LHOP'PER\~~~032\~ . ~~:t.CO'MMENTS:S*~':';<;~':.<<;L.. ,~,,'" _.- _' :':::YAMOUNT'P AIDT :"' ';;.:{f;ii;}::C~;.:"'~ 1 , ., , ___ _'_ _ _ . -'.-- ,c""" '" __ GIBSON JARRED & MARION K 94.77 ! :PAYME':rro TYP.E _ Credit Card 4842 TOTAL PAID: 94,77