HomeMy WebLinkAboutPermit Electrical 2011-3-30
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753' FAX(541)726-3689
DEPARTMENT USE ONLY.
122.6/1 -COSI
Penmt no.:
Date:
::5/ So/20 I;
This permit is issued under OAR 918-309-0000. Permits are non trans fera hie. Permits expireifwork is not started within 180
days of issuance or if work is suspended for 180 days.
',' .... 'LOCAL: GOVERNMENT APPROVAl< "'0,';;'< ~.~'~/\;:,<;-';k:-:<l~T~f;:i)<M~2r~~:t:'f,E_E\{5GHE_D_U LJEf';ff~;T;t~~1(~1~l~?8t~~~1>f:~~?;3'
Zoning approval verified? DYes DNo .. .' Cost Total
. . '- '. ',.' Qty.
.~N~~~.~r' ?.f:inspe,ct~o'ris ,~~.r::~te.~,'(.). ;:.:. .;:"ea:" cost
',::',;, ",';CJl.TEGORyCOFCONSTRuctION' " . '.'
\,' ,.., Residential, per unit, service included:
zfResidential I 0 Government T 0 Commercial
1,000 sq. ft. or less (4) $134.00 $
!f:!<~~I*iW.'l.oB;ZSI"fi"';INFORMATIONrANjjy,1Z0CATION~;;h,~1,;
Each additional 500 sq. ft. or portion
Job site address: f30u p('nE Sf thereof $ 25.00 $
City: Sfrl""r-idf) I State: OIL I ZIP: '17<f~ Limited energy (2) $ 32.00 $
Reference: \P U.JfV ./tr~ I Taxlotfl- ItV Each manufactured home or modular $ 63.00 $
,'" DESCRIPTION "".,. dwelling service or feeder (2)
OF WORK "., ..' .
RFPt..1t:6 S f3MkE T Services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 81.00 $ !S It
PROPERTY OWNER 201 to 400 amps (2) $ 95.00 $
Name: I5 fl-RN00 '" . f)fu&..s ~ \ 40 I to 600 amps (2) $158.00 $
Addre s;",n?-n\ V \.\"1. Q I('\l\ Q ( . ') Dx 601 to 1,000 amps (2) $205.00 $
Cii)\; \\ QI"\I' ti. on r ':nl-rS\ate: ~zIP:Lll Over 1,000 amps or volts (2) $469.00 $
Phonl: - - ~Fax: .. - Reconnect >T!y:\?tl.::!~' ?;e+g^~n:, ,,:~e ~f~HqJ~ a~t
....."... ._.~- --1-- -J ... ... -~.
E-ma;): Tern porarp;\~~m:.~,~~.~lf}rl fSt~~[~!.. iltff~lJetio/t~ Icy'Y€rr~tEf(gflhion
This installation is being made on residential or fam1 property 200 amps Or los51(2);52-001-001 0 lhr lUgh O.$'\~:f.1Oif Jl 1.
a, ,. , ,.
owned by me or a member of my immediate family. This .r.uY~1V, ._I,I..JU Illa.y UiJldill v t-I1t;,;) $~&l!QG~ 0 ~1
20 I to 400 anm~, m, tho >cAnlpr INn :0' fh 1P
property is not intended for sale, exchange, lease, or rent. OAR 401 to 600 <PllpSi(2)r for'the Oregon Utilil r1slililfii03- iO$l
479.540(1) and 479.560(1).
Signature: Over 600 amps or 1 ,600q,\fI[s.'~e~ s~g!tci;!;:j6f'~~d\,~j ~ection above
. CONTRACTOR INST ALLA liON Branch circuits: new, alteration, extension per panel
Business name: Sn:vE HAVc.JC a Fee for branch circuits with purchase of a service or feeder fee:
Address: P,O, lSor 113bl Each branch circuit $ 6.00 $
City: 6VC1. I State: OJZ 1 ZIP: -qNo I b. Fee for branc~ circuits without purchase of a service or fe'edei'fee;
Phone:S", 211_ Z(.,C.S I Fax:S'{I- -T<1/-10BS First branch circuit (2) $ 55.00 $
E-mail: .sWUfiO.H1ltJ@... COMUlsr NH Each additional branch circuit $ 6.00 $
,
CCB license no,: /47M8 I BCD license no.: 2o-'-q.z.c Miscellaneous fees: service or feeder ':lot included
Signing supervisor1s license no.: 35""'1<15 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: STWt: H1WcJ:- Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: .1A //. Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
f/ Each aad.itional inspection: (l) $58.00 $
:i?;;1:;v,~10~~~n~;t&~Mff1;~~'A'~,et1icA.NT'~;,PS"E~':?~,;~~\~.~~t:~~~'K,:@;Jtf~.',\~;;JN:~-',i"i~<
(A) Enter subtotal of above fees g)
'JOnCE: (Minimum Permit Fee $58.00) $
THIS PERMIT SHALL EXPIRE IF THE WORK (B) Enter 12% surcharge (.12 x [AD $ 9.-:
,\UTHORIZED UNDER THIS PERMIT IS NOT ~ (C) Technology Fee (5% of [AD $ 4,e.
GOMMENCED OR IS ABANDONED FOR \)) '0- TOTAL rees and surcharges (A through C): $epif "1
ANY 180 DAY PERIOD. l\. \'
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440-2584-J (9/08/COM)
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',>,~ .-\", OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811.SPR2011.00519
1300 PINE ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permilcenter@ci,springfield.or.us
RECEIPT NO: 2011000578
lDES.CRIP..TION
__ Ser,:ices 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
STEVEN EDWARD HAUCK II
RECORD NO: 811-SPR2011-00519 DATE: 03/30/2011
., . " ACCOUNT-CODE ,r AMOUNTcDUE_~~ I
224-00000-426102 81.00
821-00000-215004 9.72
100-00000-425605 4.05
TOTAL DUE: 94.77
..;i:OMMEi-!is,' "',:~;;._/,,, ..' '. - AM9UNT PAID':
94.77
.....
c-,
<'<{.,'.
'-1
I pA '(MENTTYPE
Credit Card
090390
'~'~~ 'PAYbR~-- -CA'SHIER;NMACHADO
TOTAL PAID:
94.77