HomeMy WebLinkAboutPermit Electrical 2011-3-21
225 Fifth StreettSpringfield, OR 97477tPH(541)726-3753tFAX(541)726-3689
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SPRINGFIELD)' .. V.0 .. c.v -..........: ...>.
Date:
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for 180 days.
Signature:
"", CCNTRACTORINSTAtLATION
Business name:' W V\""\: 0 \ :52x-.. 1\<:.."'''''
Address:~"'lL A. :\.e..t+or'OOV"'.
City: ~\ ;.,o,~ (\ I State:fhK I ZIP:q-]t!0.u
PhoncS4\ 6o;t<;;t- \c....l'"2.'\ I Fa,6::,ll\(A;l.,"2!..llhl\.'L. First branch circuj'(2) S 55.00
E-mail: ~ \"<\u...'S\. c..<2. L..D...v\.'\, .. ',~~~, ~VY Each additional branch circuit $ 6.00
CCS license no.:~()...35:v'l.ll: SCD license no.: Miscellaneous fees: service or feeder not included
Signing supervisor's license no.: ~I-P -r' L!7 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: -Y I A.. l i", Ic-:}; Each sign or outline lighting (2) $ 63.00 $
. I "--" Signal circuit or a limited-energy panel, /' sl ^ '"2.r
Signature of slgnmg supervlsor: alteratIOn, or extensIon (2) \/ S 63.00 \.(! v
A Each additional inspection: (1) $58.00 $
: .-iC . APPLICANT USE . :.:'" i,'
~!"II.Jq\''-l J:"
;,::,:: ~ ',~~~" '.'. ~ ~ N\' ~ \ )Minirnum Permit Fee $58,00) - - ~':' $ ?/?/...
"' "t' ~'~ (B) Enter l2%surcharge(12x [A]) .. - $_.!]~
-. .__ -, .-.._ _..... 'Of6> (C) Technology Fee (5% of [A]) ..,~ .--
'. /\\~ \--\ TO~ALfeesandsUrChargeS(AthrOUghc): ~7371~
440.2584-1 (9108ICOM) V\. ~ tp ~
I
LocAL: GOVERNMENT APPROVAL
Zoning approval verified? DYes 0 No
CATEGORY OF CONSTRUCTION .
D Residential I D Government I Iii Commercial
JOB SITE 'INFORMATION AND LOCATION
Job site address: ' r "'A r \ ~ I DV'\a lJ I ,'v, ,
City: SOl \ w'.L, 0 H I StateY"< [,) ZlP:C('1CJ.,,- (
Rcferenc~:, 1"1 U:J\ C?14[J- , T Taxlotf1(":
:,' :;',iiZiDESCRIPTIOWOFWORK. -:e".
" ~\ . N'. "\ ..\ JdL... ~.n( "" 'v)\t v:Y).
v ,
'..' '-r', ',PROPERTXOWNER ii i.' ..:.:.:
Name -\i'\uJf.s ~\"it":tT'W..t\\:::
Address~ \I -y.;<"t' .~:a.~
IS"\."'I{) f'M &ate: I'\D- ZIP:L-r-r.tt)1
"
City:
Phone: .
Fax:
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).
"
. "
I':
I
FEE SCHEDULE
N~mber ofinspectiorispcl"item>() % 9:t)"
Residential, per unit, service included:
. .'
Cost Total
~a.; 'cost.
$134.00 S
S 25.00 S
$ 32.00 $
$ 63.00 $
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured horne.or modular
dwelling service or reeder (2) ..-
Services or feeders: installation, alteration, relocation
200 amps or less (2) - .' $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158,00 S
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps orvolts'(2) $469.00 $
Reconnect only (2) .. .,. $ 63.00 -$..
Temporary services or feeders: installation, alteraltion, ;elocatioll
200 amps or less (2) . --- , '" . . -$-63.00- $
-- ..
201 to 400 amps (2) .' $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see seivices or feeders section above
Branch circuits: new. alteration, extension per panel
a. Fee for branch cin::uits 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:
$
$ .
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541~726-3753
www.cLspringfield.or.us
811-SPR2011-00452
400 INTERNATIONAL WAY
permilcenter@ci,springfield.or.us
RECORD NO: 811-SPR2011-00452 DATE: 03/21/2011
~~t;tff::';ca;r.i:;:':~ ~:-: ..:" ACGO:UNJIC-0('jE7:;;i0'.;-~-:~i:,AI,iiO:UN;tjjlJE; ,T 'c: . c;'~
224,00000-426102 63.00
821-00000-215004 7.56
100-00000.425605 3.15
TOTAL DUE: 73.71
F .PAYMENT'TYPE"'''' PA.YOR.: 'CASHiER'NMACHAoOT; ',T T' {:COMMENTS-.'"'' ,'. ""-'dAMOUNT'PAIJ)'. . ,'., i ,,'J
"-'>... ~"~,,,'__'_"_'_"__ _,'",_,__.,~..",.__.., ._. _..-'--_~_._"~,~,__.,,.__"""""'.,_.~4-""'''''~_..._.._.. ,_"",._ _ ._."i.... .---.._-"-----'----.-ol.. '__'~"__""'~""--'__""_'__
._........1
Credit Card Steve Cochran 73.71
RECEIPT NO: 2011000513
lbESCRiR:tjON'.'.::.r.;;c;s~,;':~: "'\ .:..:
Stan~:~lone limited energy, multi-family
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
04086c
TOTAL PAID:
73.71