HomeMy WebLinkAboutPermit Electrical 2011-3-23
225 Fifth Street. Springfield, OR 97477'PH(S41)726-37SJ.FAX(541)726-3689
, DEPARTMENT USE ONLY
'. .'
SF'ILUf!-00 '17/
PermIt no.:
Date 3-2'3-(/
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.
..,,' ; 'CbCAL.GOVERfIIMENTAP,PRbVAC.>'; ;,
. Zoning approval verified? 0 Ves 0 No
,. ;;C,6.TEGORY,'OFCONSTRUCTION".' ,
D Residential D Government C~mmercial
~0:~r'~i,tJOB.w.SIl!E;'INFORMATIONiAfllt5';il::Ib:CA:Y;IOfll~~f;";'~Ki
Job site address: 3,QOO
City: s- ",'
w".kr
ZIP: 971(77
023000 Taxlot.:ooKo
DESCRIPTION OF WORK",
W, ~
-r,
Phone:
E-mail:
77477
Name:
Address:
City:
,"OCISS w
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:
. CONTRACTOR INSTALLATION
Business name: fT' U~
Address:.y. o. 'BoV'
City: uo...v.L-
Phone: 'I - -. qJ~
E-mail:
CCB license no.: 15'/750
Signing supervisor1s license no.:
Print name of signing supervisor:
Signature of signing supervisor:
--
~-,
r~F ',:-,:,;'f,i:-:~:tf~fyf;\,~9[~0~;\},;::~F!;-I5E~\~SpH E~D OJjl;~(:~'t(rs{\f;~~11~H;;~~~r~{%~~;~~ij1fl1r
. ." '-. ',.. '. Cost Total
,N~ni~er' ?.f:inspecilo'ns per ,it~~,'(:) Qty. " ~a;. cost
.,; ", "-"" ,.
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) I $ 61.00 $'?)/
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $156.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) . $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 67.00 $
40 I to 600 amps (2) $126.00 $
Over 600 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 of a service or fe"edei"fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder ':lot included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each aiiditional jnspection: (1) $56.00 $
Pjt;j,:h~~J1~~ii~~f:!tJ,~~t;t~~tA&e"LH~AN]~{U~(EV;~;~:~:(:"'~':::_:~:i~~:~~~~,;ii~:;,~;i,,;,}j,::'~':".;_:;_:-
(A) Enter subtotal of above fees $
(Minimum Permit Fee $58.00) & I
:CIl) Enter 12% surcharge (.12 x [AD. $ .,.,z.
t(G)iIilchpoI6gy~F~Ms'Yi>1~rNrHF WORI< $ 'I,S-
~:r9TAiJiie~f.nd siiec~a:rge!l(~ !!!/i'i',j!'f C): $ ~:rz.
ATTENTION: Oregon law r ires you to
foUow rules adopted by the Oregon Utility
~otlflcatlon Center. Those rules are set forth
m OAR 952-001-0010 through OAR 952.001.,
0090.. You may obtain copies of the rules by .~ JT!t
caUmg the center. (Note: the telephone r
number for the Oregon Utility Notification ' HIS P
Center is 1-800-332-2344). .. r<:,~UTHC
~VJ~~\~~Mc"'-,cu UK I::; ABANDONED FOR
fi..~"~~J DAY PERIOQ. .
440.2584-J(9/08/COM) .~ ,\W~
>
S~1~NG.,,::E~
~""~
",...,
,:;;+., OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00471
3200 VITUS LN
CITY OF SPRINGfiELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000532 RECORD NO: 811-SPR2011-00471 DATE: 03/23/2011
tI:lESCRIf!;tION:'...:::':'::~L:.lr:-;::~; . ','r 'A.~'i','.'-";;r_ t."i::.t".,- '::'.' ';JACCOUNT~C:6DE~':" <..:.:.:::AM0UNT~DUE-" ,-=:.J
Services 200 amps or less 224-000o.():~26102 81.00 ____
State of Oregon Surcharge (12% of applicable fees) .821.00000-215004 9.72
Technology fee (5% of permit total) 100-00000-425605 4.05
TOTAL DUE: 94.77
~XMENT rveET(
Check
1214
';p';i{'" PAibR~1z;;'CASHIE-R;bB6wLsByit~:~:f3!f~~'';C'OMMj;,tiI$Zi;;:~,~;77'~:~~'~~)'~ fit:::', lIi,AMOUNTP ~IQ, ti:.,:
PROCESS AUTOMATION INC ) 94.77
> 4
TOTAL PAID:
94.77