HomeMy WebLinkAboutPermit Electrical 2011-4-19
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E1ectrical Permit Application
225 Fifth Str..t.Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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Pennit no.:
CiT,y:o:F;gpIDNGFIEED'COREGON""
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Date: -/9~ 2.0((
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
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Zoning approval verified? 0 Yes 0 No .
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o Residential I 0 Government 0 Commercial Residential, per unit, service included:
~.(Q~slif:amJ.;!:)~M~ml~~N:l\l1l;0WP';'fif@~~ 1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion
Job site address: qq&, fJ S thereof $ 25.00 $
City: C:::;n ~l. State: rlr I ZTl':9N77 Limited energy (2) $ 32.00 $
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~_~9j ~~~.-;;. -ir- L~~t~o.:?~~ ) Each manufactured home or modular $ $
dwelling service or feeder (2) 63.00
_, .. DESG.~P"rJ~~~Q~"V'I(J~R."_...,""",~~
1/Vle~ ee<t SOJ"'C"C- Do-€.. Jf'") UJOi.er f '. A Services or feeders: installation, alteration. relocation
~~(~'~~~~W!7h~~~<<~~~ 200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
Address: '/C'h :f\J r OA-lL.:"\ 601 to 1,000 amps (2) $205.00 $
City:<;-ll!Vh\ 0 I State{ W I ZTl':r~ Over 1,000 amps or volts (2) $469.00 $
Phone: (- - , I Fax: - Reconnect only (2) $ 63.00 $
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E-mail: Temporary services or feeders: installation, alteration, relocation
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This installation is being made on.residentiiil:oflfaHD.:property 200 amps or less (2) $ 63.00 $
owned-Bj Qir~9rl~.fll~;IP9~r\ot.~~~~1:ie,*~,rf flfrrlll~ This 20 I to 400 amps (2) $ 87.00 $
property:lS'not'm!~c;I~.Moris*~exchang~jeas~ or rent. OAR 40 I to 600 amps (2)
479.540(1)~~:419.560(l)~ 'p.,Bp.,\,\OONt rv' $125.00 $
.\U,I. . 01'1 \~ Over 600 amps or 1,000 volts, see services or feeders section above
SignatuI'!':N\E\,\CED. ~rO\(\[)
.. ':(ii0.~liiRli,cm~a;~!Jil~!1'-~!l5ir~]'Q.~~if_J~!iri' Branch circuits: n~ alteration, extension per panel .
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Business name: J[ i<< Fly?, ,'"" a. Fee for branch circuits with purchase of a service or feeder fee:
Address: 3'6'S't.{ ,T rL "",,}Q r Q,.j Each branch circuit I $ 6.00 $
City: ,SO.['). II State: ()r I ZIP: n.-"-I7'1< b. Fee for branch circuits without purchasdof a service or feeder fee:
Phone: / -0' II 7Aq-/674I Fax: 16'f1- 7C/6 o tJ,.) First branch circuit (2) I $ 55.00 $
E-mail: Each additional branch circuit 9- $ 6.00 $
CCB license no.: It/;.(~S-I BCD license no.: -:JtJ ""):J..7c. Miscellaneous fees: service 01' feeder not included
Signing supervisor's license no.: dl00..:5 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: j[ ()~~ ).. 1 . 'J::'1 Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: _ II. / / 1 A /I. .--" Signal circuit or a limited-energy panel,
alteration, or extension (2) $ 63.00 $
~V;~ Each additional inspection: (I) $58.00 $
ATTENTION: Oregon a'l requi s yo .1.0 - ,- A:e~filllq~Mf~K_~'
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iollow rules adopted the Oredon tllity . -,,-. " .. ._t.....
Notification CenteL Those rules a\. et forth ~\~ (A) Enter subtotal of above fees (1.
in OAR 952-001-0010 through OAR 952-001- (Minimum Permit Fee S58.00)
0090. You may obtain copies of the rules by ~fv~~ (8) Enter 12% surcharge (.12 x [A]) $
calling the cenler. {Note: I.he telephone (e) Technology Fee (5% of [A]) $
number for the Oregon Utility Notlflcalion r~ 11 r--. '"
Center is 1-800-332-2344). TOTAL rees and surcharges (A through C): ~vX-...) /
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440-2584-1 (9/08/COM)
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00630
496 5 ST
permitcenter@ci.springfield,or.us
RECEIPT NO: 2011000743 RECORD NO: 811-SPR2011-00630 DATE: 04/19/2011
lbESCRII?.TION:....:.;;:j;~~'>'.~",.. t,;'P'iJi['-Yri;'VCI;' i.'A''; h.:: ?f-I/:-AC.co.i.JNT~c6DE[T;'7ifi_ ,y :'ii:::::''AMOUN:(b.UE',: ei':Cp .~,
Branch circuits without service or feeder -1st circuit 224-00000-426102 55.00
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Branch circuits without service or feeder - each additional 224-00000-426102 12.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 8.04
____. ~chnol'?gy fee (5% of permit to\a9 ________. 100-00000-425605 .. ______ __ __3.35__
TOTAL DUE: 78.39
LI1AYIVlt;:tiI5XPE,.,' ,t~'P.:a.:Y.())~ ;",cASHIER.NMA'c'HAoqtj""',r":::'C_Q.MnnENIS~-;;;:.ii~}.. -. : 'C. - '\,,A,MOUNTPAID. :.': . .~1
Credit Card JEM ELECTRIC 78.39
483284
TOTAL PAID:
78.39