HomeMy WebLinkAboutPermit Electrical 2011-2-14
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F,lectrical Permit Application
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225 Fifth Street. Springfield, OR 97477. PH(541)726-3753' FAX(541)726-3689
SPRINGPIELD
~~.
;"'",,,'" YiIIJI
'. ". DEP,ARTMENT USE ONLY
5Pflzo('~c 230
Permit no.:
Date: Z-j'l-j!
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.
. L()tAL'GOVERNMENT.6:P.P~O\fAl:>' ".,t;,.
Zoning approval verified? 0 Yes 0 No
,,. .<.C,6,TEGORY.;dFCONSTRuctION'}r,
D Residential D Government D Commercial
~~4Wi~JJ,()B;;;S.IT:I:"lINF".d~MAj;loNiiii.NI:lr;iGO,t'A'liION;~M~it5,:''f'i
Job site address: /07'- ,. 6" sr,
City: UJ State: OR.
D3351
DESCRIPTION
(fefLfltCE- 200 f'\ I
PROPERTY
:r11 C(u
107
Soy":
Name:
Address:
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:
CONTRACtOR INSTAllATION
Business name: 9(€~ ~~
Address: fO fYJX (;b3
City: fltAr;fI1$ /I1Q
Phone:5'fI-~q/Z "2-05""0
State:e1C. ZIP:1745
Fax:S'fI-T'/b. O'?/9-.
E-mail:
CCB license no.: qS17~
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor'
BCD license no.~ 31'3 C
46C{4- S
5f(!I)eIV G6/ Ste~
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
'In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
~ COMMENCE
.~ ~ ANY 180 DA
~~
440-2584-) (9/08/COM) \ v ~ \:l....
'CY" \J"-
NOTICE:
THIS PERMIT
AUTHORIZED
!;~ ;;~;;':':ftf~~{~\t,)0-Frf~~~r};Rf::?~;F,EE'?~S_C.H E,P.liItjE:,j;:Wf;i;';,f~1)1(~;Wf~~~~~~~~:'
"'- .~,;~" '. Cost Total
Number<i.f,inspectiorisp~ritemO[ 'Qly, ,
. ' ,"'~;""'.".'" "-' - "_..,,.~,., .,' y ., p-" - ._-.~", '.... ," ~i' '\ea~';, : cost
Residential, per unit, service included:
1,000 sq. ft. 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 $ $
dwelling service or feeder (2) 63.00
Services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 81.00 $q\
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) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration. extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00" $ .-
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder l10t included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal ,circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
;::i~~:~~;~at1~~~~t~(i:~~~~if~!~p,ebTc:ANTNu'SJ~1:j.~~:~i2':iC;~f,;;i~~;~:i~r.~:S~~:;};.I>:, '.':
(A) Enter subtotal of above fees
(Minimum Permit 1"0.'$58.00) $ ?/
,
Sll~llln\eB2py, \iJ;:.~~ ~~J,.jt $ "7Z:
~G;.\LT.~f~.?5% uy $ &fOr-
~ e '1.'i1li su'i-charges (A through C): $ 9tt"!7
.Y r't:ntuu.
...
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SP~:~.~. F.IEL~
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~OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.u$
811-SPR2011.00230
1072 B ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000277 RECORD NO: 811-SPR2011-00230 DATE: 02/1412011
lDESCRIe.TION. _V"-:J;:,0;~;'Y, -\f~:,,;'iJf;2'-,';Al;f:'71:"-;\';-_'AC;e-d[jiilJ~c;6I5E L'" -, 'AMOUNf.DUE-~"-.;;;..':J
-3ervice~.20~_~!'.s or less __----324-00000-426102 81.00
~ale of.9reg~'2..~.':charge (12% of ~pplica?le fees) 821-00000-215004 ...!}.}2____.__
Tec~nology fee (5% of permil lotal) 100-00000-425605 4.05 .._~
TOTAL DUE: 94.77
Q::~:: ~~~COM'MENTS~~' ,"~~,:' ~" "~: (;*>,g~{t::~:, ~"A~OUN.Ti~A.JD'.;'--,;'F"~ ','2~~~~j
94.77
LPAYMENi:&RE".-~~ ;:'PAX.OR -'cASHlER::080wLS'By't-
Check STEVEN'S ELECTRIC
3472
TOTAL PAID:
94.77