HomeMy WebLinkAboutPermit Electrical 2011-3-14
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JBELECTRIC
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El~ctrical Permit A lication 9PRINGFlEI..i:l :-1-"'r~,~,.~ DEP.ARTMENT USE ONLY
. D t' . tft $r>tz z..O/I-O C 'i/6
. ..~,~.....~
itI '" ' Permit no.:
225 Fift~ Stroot.Sprlngneld. OR 9747HPH(541)726-375H FAX(S41)726-3689 'I.~- ~,
Dale: -S -ILI- ff
This permit is issued under OAR 9] 8-309-0000. Permits are non ransferable. Permits expire if work is not storted within 180
days of issu3nce or if work is SlJspende.d for 1 SO days.
.. t0iZAl:\;iOVERNMENT Ar:>~R;@V,f;iC .' . ... .'. '.~i:./." rFj;$'StWli!1P'lJIit(EF ( ,~.-:. E'r:<i ':'.:;'i':--\' ij;~: (:~(':f;:'~{i..~}~:~i~
,:,.""., .1.'" '.,. .'-.:': .: ..i: -; /:.:....,
Zoning approval verified? 54. Yes DNa . . ..... . Cost '. Total'
Numb~i oLIMpeetinn, pedtemO . Qty.
,C</HEGORy:qf! .~'Q'N$rRIJ)~tICiN... '. .. ca. cost
o Residential 1 0 Government T SCommercial Rc~idcntial, per unit, sel'vice included:
~'r-i;lifGa'-~lJ1;e IN"'l;!l:tfll\:6)1lfI'01ilI!:'~t<i~flZotl'1A-:r:lilN-"" 1,000 sq, fl, or le~, (4) $134.00 $
:lli:Yfu;: ,:;y ,,' -- l.. JI.' ~) !~ (':. " ,,:" '" ,,'. Ii i: ' (: ,," I :~\ _ ", ; ....\':~ '0" ': , '.,'~ (l:>_ ' " :~~y..t;Y:"i:':=-::';, ~ Eacn a,dditional 500 sq. ft. or portion
.fob site address: AI~ -r-' ,- f ?-C' $ 25.00 $
thereof
City: h?/l/l~ -/ ,f..J1 I State: c:'fi2- T ZIP 97l.{77 Limited enorgy (2) $ ROO $
Referen~t 1"763 1St.( C I TaxIN,:OC seO Each manuf~cturcd home or modul~r $ 63.db $
DE.SCRII'1'1<;>N,0'F 'V\ItlRK!. ..... ,.<.:/,'" dwelling service or feeder (2)
- . ;r::;:...L!- ~ /I -4.,- Services or feeders: 1nsta,UaUon, alteration, relocation
/....e/U\O d-
.5 f.)//"-6L. ~ ~ 200 amps or Ie" (2) $ 61.00 $
'PRpF'ER:r'T'.. qWNER. 201 to 400 amps (2) $ 95.00 $
Name: HAW!:' S 1" ,^\ll!'~.L +s l.l. '- 401 to 600 umps (2) $168.00 $
Address: 1>0 '13 Cl X 7S~8' ,601 to 1,000 amps (2) $~05.00 I
City: el.,....(:#;;Ne I State: 0 \'2.. TZIP: '7 ?I{()I Over 1,000 amps or vol" (2) $469.00 I
Phone: - . I F6X: - - Reconnec:t only (2) $ 63.00 l
E-mail: Temporary services ,?r ftlCdcrs: ;nJ'tallati"n, alteration., relocation
This inslallation is being made on residential or farm proporty 200 amps 01' less (2) .L $ 63.0C l b-~
owned by me or a member of my immediate family, This 20 I to 400 amps (2) $ 87.00 S
property is not intendod for sale! exchange, lease, or rent: OAR 4,0 I to 600 amp, (2)
479,540(1) and 479,560(1), $126.00 $
Signature: Over GOO f1m.ps or'l,OOO volts, see services or fcedcrs section IIbove
,CCiNTRACT:O'R INSTAt::LATION Branch circuit!l: neW, a/tera/l'on, e.rtenslol'1 per panel
Business name: .J/5 8~c- - a. Fee for branch cil'cuits witb purchase of a servJce. or feeder fee:
~c-
Address: ,--;-; ~ ~ L.. ~r/. tr. Bach branch circuit /M $ $5fl.{
6.00
City: /' ~ I State: ?>.e- I ZIP: CJ7?f:;;2.. . b, Fce for branch circuitS without purchase of a service or feeder fee:
Phone: c;-t// -I. g? -_V7'/O Fax: 5"L//. _-=0';;' 71'.rf?~ First branch circ~it (2) $55,00 $
E-mail: .Jc;/ &:;>.,. /t, 0/.... ,~ '"z~ l / Bach additiona.l branch clrc\,Ilt $ 6,00' l
.
CCB license no.: to~ I.BCD license no.: 37--S1("7c;.. Miscallaneous fees: sf.~iJice or.feeder ~Of included
Signing supervisor's license no,: 3~~_ Eae~ p\lmp or Irrig,,:lon olrcle (2) $ 63.00 $
Print n.ame of signing supervisor: .:-1;;;{..... gJ?~-k~ Each sign or outline lighting (2) $ 63.00 I
Si " -. of signing S1.ll:~r~Ri~ J -. Signal circuit or a llmited~encrgy pfll'lcl. $ 83.00 ,\
.--- altcration, 01' extension (2),
~n ~ - ---
- EHh R~lditiollal jn;pection~'(l) $58.00 ,\
:., -- ,!;:,"''2~,O~Xii:"''A:Pil'':WI~'' t1, ..
,:(;,:;:-<'.') ,..:,,-,. ~~~::~}...1' r\' \;, " :J;,:.(JS. , . ' " '.' ~:':. . ~'.:
" ,"". ~.. ,,, ~ '. >"-' ". '. ,',' ',.'", .' . .' . ...
(A~ Enter subtotal of abo,'e fees $ / ':/""
~.~ ATTENTION. Oregon law requires o'(\Yl.1himum Pormit Foa $58.00)
n I ,,~,l,
, d by the Orege ~, ..~, $/.,GCf
follow rilles adop,e ose rules arE : <(a.bfn\er 12% surcharge (.12 x [A))
Not\licatlon Center. Th. 'I OAR 9 )~G~Ij;.chnology Fcc (5% off A]) $ 7"JS'"
~tttt . in OAR 952-001 -001 0 thl~ui~~ of Ih\ . ~'tq,o~L, fees and ,urcharges (A through C): $ 171 "
0090. You may obtain ~ofe. the lell P"v"'OTIGE
calling the .centel. (on Utility No ificatr~n :
number for the. 0~e~00_332-2344 THIS PERMIT SHALL EXPIRElF THE WORK
40-2584-) (9/08/COM) Center IS - . AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS Ar i\I'j80NED FOR
- ^1,'I"(1 r ,.......
,,1\ ! ,,0 D.'\Y P,:<"
....
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SP~I,N._.:=~~
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~OREGON
www.ci.springfield.OLUS
TRANSACTION RECEIPT
811-SPR2011-00416
400 INTERNATIONAL WAY
CITY OF SPRINGFIELD
225 Fifth St
Springfield. OR 97477
541-726-3753
permitcenter@cLspringfield,or,us
RECEIPT NO: 2011000488 RECORD NO: 811-SPR2011-00416 DATE: 03/15/2011
IDe:S.CRI~TION .... :::-.7"':-';.:"-: .';ii'iC:~f;'~.78,:_", ,.;,~: : ACCOUNJ:C.oDE ',e ;;";j~.' :~ .,'" AMoiJNrJiue:i ,..',. 1
Branch circuits with service or feeder each circuit 224-00000-426102 84.00
State 01 Oregon Surcharge (12% of applicable fees) 821-00000-215004 17,64
~_ Technology leej~~_ol permit total) 1 00-00000-425605 _...?:~~____
_..!emp services 200..~~..'!_ or less 224-00000-426102 63,00
TOTAL DUE: 171.99
LeAXMEr-{1)YILC2PAY.98.'!':CASHIERNMACHAb'o",c:,,, T"C_Q.I'II_Ii11=NTS1::i,,:'~:. ~. . '.-/: tAMOUNT'f'AID, ',' -::-:",--:..:.J
Check JB ELECTRIC INC 171.99
12126
TOTAL PAID:
171.99