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