HomeMy WebLinkAboutPermit Electrical 2011-4-4
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
DEP,ARTMENT USE ONLY
I -502- 2-01 ( ~Oo~~'1
Pennit no,:
Date L - y,... 20 ( /
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.
I
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(A) Enter subtot'\l;.oJ'ii1j5-vefueSY. t5 i)
(Minimum P~it Fe~~;6)' $ .5 g.
(B) Enter 12%surcharge(,12x [A]) $ '2- )()
NOTICE: (C) Technology Fee (5% of [A]) '$ 0c:.
THIS PERMI"'~..:rJi\~_fi!'\,SerJ\:'~k+dlJrough C): $(/J/'~ ~
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
i ',', ',l(OCAL: GOVERNMENTAP'PRovAl',.:., /'; i;C:';
Zoning approval verified? 0 Yes 0 No
,>. '",CATEGORY;;OFCONSTRUCTION':' ',',
tJ Residential I 0 Government I 0 Commercial
{~?~oi!?i%jOB;~Srr:E;;1 NFO R'MA;nO NiAN [jid.!OCA'tION':;~;;,:':(;;
Job site address: '10:3 . i/.4,t!,c..~W /.2.cP
City: S; ,de; +:'t- b I State: I ZIP: ' .
Reference: \11[ 'In tn I Taxlot.:U')Y{1Y:
. ',' 'DESCRIPTION OF WORK" ". ",.:<' ,:"
I C-Kt 5,<;w C~' /J. P
PROPERTY OWNER
Name: J.I~,u LJ /'./ JV"oAJ "',,<
Address: /~J 0<:" ,__,,;;.... -/J, ~ ~
City: EV9G.t/Z -r State: d,(! I ZIP:
Phone: S-f.LI- .PO" - 5.:f~ Fax: - -
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
,CONTRACTOR INSTALLATION
Business n~me:~h(R/.s Iof.< I;~ 6~/' C:..
Address: S?:?.,;fJ- / l>Y't..t.t.<J 1&-)) ~
City:r-.Ll~. ,......, I State: 0;( I ZIP: 1~26
Phone: <'7-1 - 9<'2- ~, ~T Fax: - -
E-mail:
CCB licens~ no.: /2 :577 I BCD license no,: 2-,0 -22-/c
Signing supervisnr's license no.: 3 ""-2- IF' .S'
Print name of signing supervisoru",'=r";"'~ V. .11./,1.
Signature of signing supervisor:;/""P?./ ;r:~ ././
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-001-0010 through OAR 952-001.
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification'
Center is 1-800-332.2344).
~
&
440-2584-J (9/08/COM)
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/"Yi;J:~i\h:.:t;~::~~i?~f;\ifirS1.~t(i~~,E-E;{;5-~H EJjJjDE~;!~~f$j~;~'~~f(~~r~r:'~;~~~S+~~j~~
,N~niber ofinspediori, peritem' 0 . Qty. Cost 'Total
_".". .,1" '_.." ..~-.;.' 'I,"'.~'.-'.. 'ea,". 'co,st
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) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
I
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or Jess (2)
201 to 400 amps (2)
40 I to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126,00 $
Over 600 amps or 1,000 volts, see services or feeders section above
B:ranch 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"eder'fee:
First branch circuit (2)
Each additional branch circuit
K.
$~i;
$
$ 55,00
$ 6.00
Miscellaneous fees: service or feeder ':lot inciuded
Each pump or irrigation circle (2) $ 63.00 $
R Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each a(Jditional inspection: (I)
$58.00
$
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. ". - .~."' OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00539
703 HARLOW RD
permitcenler@ci.springfield.or.us
RECEIPT NO: 2011000650 RECORD NO: 811-SPR2011-00539 DATE: 04/04/2011
lDESCRI~tI5N" -..;, *' ~'" "..f."i~!lt'~t'''''7+*;'7' ~;";;"~\l'tE~i%'.iA.:cc5uNT{c5oE~' ~'-': ,',<E!'"lt";AM5LJNfDLJE~;r~ ,., . J
Balance of Minimum Electrical Permit Fees 224-00000-426102 3.00
Branch circuits without service or feeder - 1st circuit 224vOOOOQ-426102 55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 6.96
Technolo~y ree (5% of permit total) 100-00000-425605 2.90
TOTAL DUE: 67.86
[~:PAYMENf,l;yJ?E:':' "2P~'t''oR;:CASHIE'R~Nr.f~f~AD.9'''11F'';:;Lc9IV1MF;~IS~',:::": .To,.:- ,"ff ;"AMOUNT.pAID"- ""c.'-;' 'j
Check CHRIS MILLERS ELECTRIC INC 67.86
3601
TOTAL PAID:
67.86