HomeMy WebLinkAboutPermit Electrical 2011-3-10
EI~.ctrkal Permit Application
225 Fifth Street. Springfield, OR 97477.PH(54l)726-3753+ FAX(54l)726-3689
bEPA~TMENT USE ONLY
~~~t>(I,OO '37
Date: .... -10 -(
This permit is issued under OAR 918.309-0000. Permits are nontransferable. Permits expire if work is not slarted within 180
days of issuance or if work is suspended for 180 days.
THIS PERMIT SHALL EXPIRE IF THE WORK
~UTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
,'[bCAL',GOVERNMENT ApPROVAL"'''>'! "
Zoning approval verified? DYes DNa
'. .."... ,"';CATEGORY.'OF:CONSTRUCTION;'~ .,
o Residential 0 Government l".la'Commercial
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Job site addr~: ",.{. C)Q ~ if <)"1 -f ( ..:If / '
City' L.j 0/ II' I v1 State, oct ZIP,<; -
Reference': 1'"(.)2. '"5 200 Taxlot.f"'\r-,. q...) (""
.' 'OESCRIPTION OF WORK ,'".,,;"',.'-
() n (J- I. '" m , 1/ .:~ T n-f Yl
\.. \l/'I-LVII 1---1 \./i-f1/1-f
PROPERTY OWNER . ,
Name: :n W,," V."{.iW./r IIPT~
Address: 42.b 1rr.lodtjA.... s~ 3.08
City: CtfrC,.o I State:CA ZIP:'1~ 7lJr
Phone, . . I Fax: - -
E-mai!:
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).
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CONtAACTOR I~STALlAJ7'ili1N (I -
Business na~: IJ f) V r '1 /1. I" )'V OJ
Add~essl ~ () ':") 0 i. J (//'7 _ r
City:Wf111~)'Vil/'f I State{) y zrfT /Y.'t)~
I Fax: . .
Signature:
Phone:
E-mail: ~ i I. i
CCB license no.: I :") lrr r w, BCD license no:'A.. {H /(1-.1,
Signing supervisor's license no, /\ --J..I..h-l / ~ A, I
Print name of signing superv'" tit) ,}/VA I )T/V V Y\J
Signature of signing supervi or: I
'0~9 \
ATTENTION: Oregon law requires you to I\... '(\.\~ r.J
follow rules adopted by the Oregon Ulility J,)~
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 \J'-I
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
:~OTlCE:
440-2584-J (9/08/COM)
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,N~m~~ro.f.inspe~tio~s p~rii~~O" Q'ty.,<;,~~t 1~t~1 '.
Residential, per unit, service included:
1,000 sq, ft. ar 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 ar less (2) $ 81.00 $
20 I ta 400 amps (2) $ 95.00 $
40 I ta 600 amps (2) $158,00 $
60 I ta 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Recannect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
40 I ta 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over ~OO 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 yfa service or feeder fee:
First branch circuit (2) I $ 55,00 $ S~
Each additional branch circuit J $ 6.00 $ /.,
Miscellaneous fees: service or feeder ~ot iAcluded
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal drcuit or a limited-energy panel,
alteration, or extension (2)
$ 63.00 $
$ 63.00 $
$ 63.00 $
Each ailditianal inspection: (I) $58.00 $
;~~~iiX:Z;{4~'3~2[t~~Y~;~~1t;;r~:'ARe'.OT~AJ~t9-:USE\!';~;t/:~:~~:~l;f~?;~~!.fts:;i;;1E:~:":{.::'
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
$6(
$ 7 ']'Z-
$ 1'S""
$ //'f ·
,
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S,P~N::E, ~,O: -,
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~.OREGON
www.ci.springfield.or.u$
TRANSACTION RECEIPT
811-SPR2011-00378
4885 ASTER ST. APT 71
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726~3753
permilcenter@ci,springfietd.or.us
RECEIPT NO: 2011000441 RECORD NO: 811-SPR2011-00378 DATE: 03/10/2011
!DESC-R[e.tION".i,,~~:;?':t:,:r"'i'!':"lj,;;~~;!: '-'!,;;?:P~fl!:"::::::Acc6uNjlc6DE"_':f---'7~.;~ ." -':-JiifAiVl0.l:fNt5.u E. J '....;;,,1
Branch circuits with service or feeder each circuit 224-00000-426102 6.00
___w
Branch circuits without service or feeder - 1 st circuit 224-00000-426102 55.00
State of Oregon Surcharge '(12% of applicable fees)..~o>__~_________~31-0?9.2.9:~1500~_ 7.32
___.2echnologY..r,>~ (5% Of_E~!_~~ total) 100-00000-42560~__.__ 3.05____
TOTAL DUE: 71.37
to',--.."-------..C._ "---"",'''--_''_--=--'O>';;;$?o'r''''__'-~''---~",-,,-,- "-' -"-=.' AMOUNTP.AID '.."'.'.' I
w[ft8XMl;r..u-,TX~E:~;6e.~Y;.Q,B"";'-" CASHIER:"DBOWL~'!;!Y$j,,~~f~~C~QMM~J';,JrU~~~:!1L,:Lf$ ip') '; '~i, . ~~~~~"'"'~_ .. '_ ,,~ .Ie ~.,~ _ ~;;;:;:.;
Credit Card BURRELL BROS ENTERPRISES 71.37
00559d INC
TOTAL PAID:
71.37