HomeMy WebLinkAboutPermit Electrical 2011-3-14
225 Fifth Street. Springfield, OR 97477.PH(541)726-3753.FAX(541)726-3689
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Date:
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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.
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Zoning approval verified? DYes D No
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o Residential I 0 Goverrunent I 0 Commercial
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lob site address: II '-\1 ~n C'\ ~t". '/1)1
City:....~\ ~ r\ I State:N ___ ZIP~1A1'
Subdivisi~:\ 11fi) <0.. ~() Lotno[) ~i r
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Name: 1___\ <::;.( €..J \)n,'Jr..,. /
Address: "\"1.C\"\. \('2..- ~_'^" ~-' n \
City:'\("'\\.. ~~ I State: f"\~ :J I ZIP:Q'14.1<iS
Phone: '- \.: ~rt, f'ln . ^ .A-I.......'
E-mail: .IV\..
This installation is being made on residential or farm 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:
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Business name: r-:;'!.L <; -t- l.cili"i: rJ':. d.4;C .-,...., ....
Address: 'Kf'iZJ97 ~"z5?t- L l'?V;Ll .
City~,.(;:"_ T' .J I State:o..c I ZIP: 9"7,/)Jf
Phonx;3Y!<:rr,t;- '7P<.'3 '71 F~9'f ).y,~ -02.96/
E-mail:.sq'~'4.A~ ~"",.:/YG /H-S~' ~'V;
CCB licen~e no.: /77'-Y/hl BCD license no.: C.~ ':?L I
Signiog supervisor's liceose no.: 717'70--S:'
Print name of signing supervisor: 4,/A<iVP'e h1 ....s-~: ' .
Signature of signing supervisor: ~~- ~, '--z'/'
~H~[';:~MIT SHALL EXP~ T~~ '~ef{f ce:=
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED f~ .
ANY 180 DAY PERIOD. }~
~,
440-2584-J (9/08/COM)
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.Numb.)"ipfiinspeCtio~~\P_elllliemW)~ .QrY' i t.~~." ,~Qt.at~
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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 $ 63.00 $
dwelling service or feeder (2) Services or feeders: installation, alteration, relocation
200 amps or less (2) \ $ 81.00 $??\ .a:J
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 oniy (2) $ 63.00 $
Temporary services or feeders: installation. alteration, relocation
200 amps or iess (2)
20 I to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over 600 amps or ] ,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 I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch ~'~;~N: Oreg n raw rlea?,Il\l,. $
Each additiotblo!ifill'<lt~ff . 'oy hl$ Clr.BID '{iijtj1;~,
Miscellanenu~~tl.g'itIfi'lql'll.,... ~e set forth
Each pump o~OOtal co~ iet 91'IW..t~S=-UU1.
Eacl>sign or oull~ifu!l(JbJe Or~' ",U:E J~l@Jteie ~ne-'
Signal circuit or a limite!r-~ ~ 0-3 2ils~'~~1/ c~tlon
alteratlOn, or extensIOn (2) ......".
Each additional inspection: (I) $58.00 $
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(A) Enter subtotai of above fees
(Minimum Permit Fee $58.00)
(8) Enter 12% surcharge (.12 x [A))
(C) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
$f)\SXO
$ {; ."1'1
$ l. . r-~
$(1 ^ - 1
\\" .
SI~RIN.GF.IE~....
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OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541~726-3753
www.ci.springfield.or.us
811-SPR2011-00411
7797 1/2 MCKENZIE HWY
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000479
[OESCRIP..1JON1;ki'; "'1:~7~ .~;.
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of pennit total)
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RECORO NO: 811-SPR2011-G0411 OATE: 03/1512011
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224-00000-426102 81,00
821-00000-215004 9,72
100-00000-425605 4,05
TOTAL DUE: 94,77
COMMENTS', ;;,:LTC- "i~IT":; '':;JAM(jUNrPAII')~R
94.77
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[PAYMENT TYPE" ';;:;':;PAYO~' cAsHlefl:L1'OPPER - '-~
Credit Card FIRST LIGHT ELECTRIC INC
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TOTAL PAID:
94.77