HomeMy WebLinkAboutPermit Electrical 2011-1-18
08/19/10 THU 16:15 FAX 5417263689
CITY OF SPRINGFIELD
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~~s Fiftb Str<<t.Spria;fi"d, OR 974'77>P1I(S41)7~6-J7S3>FAX(S41)7U-~89
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Electrical Permit Ap
This permit Is isslIcd under OAR 91S-309-OO00. Permits are nontransferable. Permits .lCpire If work Is not su.rted within 180
day, of 1~"Sdsnce or If work is Quspended for 180 days. .
totAL GOVERNME~T :APPROVAL" ;,,:;. . . . .:: " ?':}~'~:<;~:~'.~~irH~,;\.~~i ::Fa:'-.$ft~QUl;E';:_:. ,~~::.~' ./A.'t:'i:{ }~:r:~tf'>:':'
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Zoning approval verified? DVes DNo .~umbe1:of1fl;~e~io.sper~()' ..... ~. . Cost:. T'ri1aI'
". ",cATEGORY':'OF :,CONSTROCitON,'i. .. . '. '. . . .. ..... :'.ea." :' .' , ~list '.
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o Residential I 0 Government o Commercial Residential, per unif-t servil!t InC:l~ded:
1,000 "'I. fl. orl.ss (4) 5.
~, "":;100 '$JTE INfORM/liTION'MfO"UOtJ(TiON ,.-, , 5134.00
~-7:''fi.:~'':':;;:'. ,,0."_~"":~'" '. ...';. "" ~'. , fi~'.. . ;' ....t~;.:7.".:..':". Each additional 500 sq. ft. or portion
Job site address: 'J" ~\ "\ -\1r--" thereof $ 25.00 5
City: _~ Ir State: on I !zIP: U1411 Limited en.rllY (2) 5 32.00 $
R.fer.nee:\" \ I TlIXlot.: Each manufactured home or modular $ 53.00 $
'OESCRiPTlON. OF WO~K~;. .... '.".;: ,..:., dwelling .ervlce or feoder (2)
n'( . \II Y n ,', t J 'I"" f'\ "'.011'1) Services or feeders: insrallarton, ().ltera1ion, relotation
" ht"l ~\- ":'nr 111 QIt h, " ~ - _"JJX1 ) 200 amp. or less (2) S 81.00 SRI C
F'IfOPERrf OwN~ .. \ 201ro 400 amps (2) S 95.00 5
Name: 1\' ~n lJ .l- M \l1l\ \ \. "\.0 M'" 40] Ie 600 amp. (2) $158.00 S
Address: IV ~ \.\. +~ 601 to 1,000 amp. (2) 5205.00 5
City: &J Hci- I State, nIL- T ZIP: C{ 141 Over. ,000 amps or volts (2) $469.00 5 I
Phone: ..... I Fax: Rccoaoe<l only (2) S 63.00 S' n 7V
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E-mail, T.mporary services or feed...., 1n>lall4tio alteration, ,..Iocation
This Installation is being made on residential or farm ~operty 200 amps or ,... (2) S 83.00 5
OWlled by me or a member of my immediate family. is 201 to 400 "",ps (2) S 87.00 $
prope~ is not int.nd.d for sale, exchange, I.ase, Or rent. OAR 40 lie 600 amps (2)
479.54 (I) and 479.560(1). . 5126.00 5
SignalUIll: Over 600 amp. or 1.000 volts, see services r feeders section above
..CONTRACTOR 'INST ALLATlON: Branth clrcult!t: nt'W, alttration, Ult:ns{OI1 "r JXI~.I
Business name: f'\eW \O~"O \r\S e.. \u ~l...'I'; C. o. Foe for branch circuits with purt:hasc of, s.rvlce or feeder ree:
Address: LIIs' I..JO'\';" 7.~6\' h..vP E.eh branch clrcuil I 5 &.00 $
City: eJ l..nerl?' State: nl( I ZIP, ",w'O? b. Fe. for branch circuits without purehese f. ..rvlce or f.eder f..:
Phone:S4\-'5{~ ,"/... q7 I Faxt;lJl-'!:H~ (j80~ First branch circuit (2) $ SS.OO S
E-mail: . E.ch additional brnnch oircolt S 6.00 S
CCB license no,: I&LjQZ I I BCD license no.: c...i..(~ \ Mlsc,llanoous fees: se...lce cr ftedcr .ot . cludod
Signing SUl1.rvisor's license no.: f.,l.j 04 .s Each pump or inigatlon circle (2) 5 63.00 . S
Print nsme of sillllulg supervisor: 3e~em., rQ.,,,dOJ Each sign or outline lighting (2) $ 63.00 S
Signarore of signing supervisor: ~. '\ , (\ ..s;g;1a1 circuit or a Iimil<d-energy pM.., S 63.00 $
./ alrCTfltion, or extension (2)
Eacb addltioonn..peetlon: (J) $58.00 $
~i,::':'24l':c'iBY:i..Xif;";.i:AAf'Lieo\lliilT':~~ ',';/;:::':};;;:;:'i,t:.:'6;.:.,.
(A) &Itcr subtotal of .bov. fee. S\~~
(MInimum Permit F.. $58.00)
'<~ , (B) Enter 12% surcharge (.12x [Al) sl./lP
(C) Technology Fee (8% Of [A)) 5 .Cln
~ TOTAL ree! and surcharges (A throo j,q: 52J.(x..p
44O-2.584-J (9/08JCOM)
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield, OR 97477
541-726-3753
W\NW .ci .springfield.or. us
811-SPR2011-00029
287 17TH ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000046
RECORD NO: 811-5PR2011-00029
DATE: 01/06/2011
224-00000-426102 63.00
821-00000-215004 7.56
100-00000-425605 3.15
TOTAL DUE: 73.71
ih~PAYME~T~mE'tJ1IID~hreAYQR1F!:rCASHi~I~uBb~tis~2067Jmj~~'ffj~CIOMMENTS~jfr~~j:~~~l0i~G~~t~iQg:N1i;e~ID~flTIm1 ::\1J0hH,"miahW1illl
Credit Card Dan Boaz 73.71
02743D
Service reconnect only
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
TOTAL PAID:
73.71