HomeMy WebLinkAboutPermit Electrical 2011-3-14
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03/1~2011 04:21
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JBELECTRIC
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Ekttfical Permit Application , . -
i1P"RINQP'nlLO ~""'-~ DEP.ARrMENT USE ONLY
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125 Fifth Strcet.Sprlngficld, OR 97477. PH(54l}726-J753. FAX(S41)726-3tiR9 11~, . '''f. Perrmt no.:
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Date: s-/tf-II
This permit is i.lsued under OAR 918-3090000 Perm't ansfer.hle. Permits e'pire ifworl< is not storted within 180
d' f" ~ . l S are nont
,IYS 0 IS'uance or ,rwork is suspend.ed for 180 day'.
I 'Ul::IGA'l;GOi1ERIilMl:m.' AP'R,~(;lY!At . .' . .' ....,::.,.'..,.;:...":<.. ~,et:'.$~a:E:I)tJf[jE..:
Zoning approv.l verified? . .'. -g( Ves . 0 No ::: ...:,,~,~.; '~f?:; ~;)i,:'~:";'~~' :~'t .:~{(:,H~J0~'
Num-bet' ofJn9:p~:ctio~!il.p~r ,it~~ (.) Qty, . Cbst I Tot"r
, ,',. ..,t;TE60RY'''OF .:CONSYRl1JCt;l'@IiI'., . .,. .. ',. en; . tost,,"
o Residential. . . I 0 Government . /-;;z(Commoreia) Residential, per Llnit\ service intluded:
f~'!'i:;;<1!i'i;~<~J3~p.BLeINf(J;i1'~IiIi~'$llOlJf:lIi'!~~nlH:L::Q~'!ll;1lifllii'l(j('f)+.,.;;" 1 ,000 sq. ft. or lcss (4) $134.00 $
, -. .', ",,~,', ':. ~ : ' ,'-'.. <' ','" .... "
.Iobl,te address: 7 yC) krc./..SJ2./././/'J.Y .' . . . . .' Each additional SOD,sq. fl, O~ portion S l5.00
City: ~'1"'.L ~>d I State: VI..e. 1 ZlP:Cf7t(? 7 thereof $
Limited energy (2) $ 32.00 $
Refer~nce~ /76 3 2 2. 'Z. 0 I Toxlot.: 009/ Z Each manufa.ctured home or modular -~-
I.... . . .'DE$CRIP,'r:IOI\I: 'OlF 'Wtl'RIF' '., ....I .... ." dwelling servic~ or feeder (2) $ 63.00 $
I .' '. .. .' ..' '.'
I ?/ti'~c.- g(2.r;- Oel1<o .a.~ YMZ-UAM?, Services or fccdcr8~ installation, airermion. /"e!ocariol1
200 MIpS or less (2) $ 81.00 $
c2 (-cart C(~ . I..... It ~1.E1<4 fl
I . . . PROl'll:RTY OWNER' . . 201 to 400 .mps (2) $ 95.00 $
Name. I-L..c> 1t{/r.{k~~VOU --- 401 to 600 amps (2) $15B.OO $
Ie//>
Address; 3' B "S- . .- dbW VIc!W . l)(l. 601 to 1,000 amps (2) $205,00 $
City: f::~f::;I:"N~- I State: () It I ZIP: ~ 'C(O~ Over 1,000 amps orvolt, (2) $469.00 $
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Phone: - - . I Fax: - - Reconnect only (2) $ 63.00 $
E-mail: . Temporary s~r",ic:oll or rocdcrs: installallon. alteration, re1cm1.tion
I This instaUation is being made on residential or farm property 200 amps or less (2) $ 63.00 $
owned by me or a member ofmy immediate f.mily. This 201 10 400 amps (2) $ B7.00 $
property is not intended for sule, exchange, lease, or rent. OAR 40 I to 600 amps (2)
479.540(1) and 479.560(1). $126.00 $
Signature. Over 600 amps or 1,000 volts, see services or fecde:r~ section above
i.t:ONTR~R 1t:l'STALkArtON '. Brnnch circuits: /1ew, alterafion, e.l:lensio/1 per panel
0, Fee. for branch circuits with purchase of a. sc"rvice Of FeedEr fee:
[ Business name: J7~~c.--~
I Address 4!~RS- ~ teSr . Ench branch circuit l $ 6.00 $
I City: ~r" _A r St.te: OiC2 I ZIP?7')",&~ b. Fcc for branch circuits without ]"lul'chasc of (3, ~el'vicc. or feeder fee:
I Phone ~fI;:. (Cg'''1.s-:;?70 T Fax: qj--:;Eh,;?-€t.::J.<9'.v First brllnch circuit (2) j $ 55.00 I S$
Each additional branch circuit '3 $ a.DO $ /---P;
. E-mall ~&&.ttr"dlk...g/!?dwc.'H?' ~
I CCB licensc 110.: 1t:7~'l'.;:l? I BCOA'i;anse no.:~.<n'7c Mi~ccllancous fees: service o/'feeder ,!ol included
Signing supervisor's license no.: (k") .--;;~" Each pump or irrigation circle (2) $ 63.00 $
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I Print name of signi.ng supervi~ -.:::I ~u._ Pru~k_ Each sign or outline lighting (2) $ 63.00 $
I ~tlJre of ~ignjng superviso?:' I=" () ---------. Signal circuil or alimitcd"cncrgy pa.nel, $ 63.00 I
alteration, Of extension (2)
J-~~ (' - --
E9Ch ndditional inspection: (I) $5B.00 $
l.~i,...";~"i-;:fX;,,', <'1;;, :i;A;P,j~'].!IG!~~[itlSE'. ... ..
..
ATTENTION: Oregon law requires you to (A) Enter subtotal of above fees $ 73
, foUow rules adopted by the Oregon Utility (Minimum Permit Fcc $58.00)
~otlflcatron Center. Those rules are set forth (B) Entcr 12% ,urchal'ge (.\2' [An $ 'B?i;
In OAR 952-001-0010 through OAR 952-001- '<~)_1;""qn~logy Fcc (6% of [AD $ 36S
0090.. You may obtain copies of the ruies by ':t:~;t X:t;(~~,~p ~d ..'m~cP ',rg~s \({\:t~ ro\ig[aj! 0 ,I\. $8S'1
calling the center. (I~ote: the telephone
"",oboe I", Ih'. 0",," Ulim, N",il'''~ ,\'UIH'o'Riz'E'o Ui~DER THIS PERMIT IS NU I
Centerrs 1-800-332.2344). . COMMENCED OR IS ABANDONED FOR
440.2584-.1 (9/0R/COM) , . ANY 180 DAY PERIOD.
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
WV'!W .ci.springfield.or.u5
811-SPR2011-00415
980 KRUSE WA Y
pe rmitce nter@ci.springfield.or.us
RECEIPT NO: 2011000487 RECORD NO: 811-SPR2011-00415 DATE: 03/15/2011
tDE.SCRIe.TION:'~~"" ";"~,/~~,~,,,, "';;";"""~~'::"';:;AC.C0UNT~CO[jE,f" '" .:.~"AMOUNT"[jUE.' '..
Branch circuits with service or feeder each circuit 224-00000-426102 18.00
Branch circuits without service or feeder - 1 st circuit 224-00000-426102 55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 8.76
Technology fee (5% of permit total) 100-00000-425605 3.65
TOTAL DUE: 85.41
t.~AYNlI:NbY~E:./ .". ' ~~Y_OR'0"-c.6~Ji~"E."AcHA~:"--"C.OM~gNIS~.h;g,,1;'. ""'''' AMOUNT,PAID, - - .::.:._J
Check JB ELECTRIC INC 85.41
12126
TOTAL PAID:
85.41