HomeMy WebLinkAboutPermit Electrical 2011-4-26
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Electrical Permit Application
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225 Fifth Streer+SprjngfieJdl OR 97477+PH(541)726~3753. FAX(54 1)726-3689
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DEPARTMENT USE ONLY
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PermIt no.: '
Date: - Z (, - I
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days nf issuance or if work is suspended for 180 days.
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". - "-120CAVGOVERNMENTiAI?F>.ROvAl!!'t:..k/':;i1''''i~Y.
Zoning approval verified? D Ves D No
,'il ~,.,:i"CATEGORY,,~OFi:'C()NSl'RUCTION:2v' ; ",;, "
~sidential I 0 Government I 0 Commercial
~~i!:~J:iI()Bi1SltE~INFORNlAiTION~;ANDfiil!!oCA'liI()N~I~'ij;~l';~
Job site address: 4sZ~ Cor t:::- (J,4...-
City: 5 j)~ h I State: OIL r ZIP~ 7'17
Reference: J 807 0 S. Z. L( I Taxlo!.: 0 ?:1OO
. 'DESCRIPTION, OF'WORK,#,:;:::'N/'?/"~
10 0 ~ P YO'-'t:n- ""?lfl\
l.Jc>-OX- S/T~ 11>~,,e-~ M L/3Z1
PROPERTYOWNER '.
Name: ---;i....... D~( J...r.""'.........
4"3Zl( C~.fe lo/Av
City 'Jit:>t'::0 I State:&" I ZIP:;:; 71( 78
Phone: - - I Fax: - -
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Address:
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:
, ;CONTRACi;oR INSTALLATION
Business name: C I rz::: 1;;7 Fl.-f7Z-{ C
Address:ff) I!>tJX 1/13q
City: WI/h. =: I State O~.I ZIP: 97t.ft,t()
Phone5''-fI-bSk-f~Cj(., I Fax - -
E-niail: /.?o TH Ii- /2. <;; <Z- 05~C4 57. /l--'io =7
CCB license no.: ,S q 7'1 <f I BCD license no.: 20 -Z-;7&'c.
Signing supervisor's license no.: 3 c; 'i.3.s
Print name of signing supervisor: To (V V 1< t:J 1t-I
Signature of signing supervisor: C/-;-:' /~ H"-
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ATTENTION: Oregon law reqUires youto ~
'follow rules adopted by the Oregon Ulllity
Notification Cenler. 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 r(\: \
number for the Oregon Utility Notification t><."V
Center is 1-800-332-2344).
~
440-2584-) (9/08/COM)
1r}(~j;:;'i;:.i~'i.~i1?i~W;'t'?~~v@..FEE-iJS' 'c, H' EDU:I~E- t[1,!:~]~1;~z:,;:~:::ftj~&:;';&;;J1:''h!
. . ,'t''':.'' ~_ .,,, r.'""",!:";;..,, -t".' _" . L: ,,,' 1'1'i'''''~",\':hi'~-'l.~{;,'1-',"'t.':~;l!;,,-;
,N~m,~~r o.fin;p~it:~,risp~~~t~~'p.',..IQ~.,~~~~ ,1~t~1
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 ar less (2) I $ 81.00 $ g(
20110400 amps (2) $ 95,00 $
40 I to 600 amps (2) $158.00 $
60 I ta 1,000 amps (2) $205,00 $
Over 1.000 amps ar volts (2) $469.00 $
Reconnecl only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps ar less (2) $ 63.00 $
20 I to 400 amps (2) $ 87,00 $
40 I ta 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, ext.ension 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 ~ithout purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00
$ 6.00
$
$
Miscellaneous fees: service or feeder ':lot included
Each pump or irrigation circle (2)
Each sign ar autline lighting (2)
Signal circuit or a limited-energy panel,
alteratIOn, or extension (2)
$ 63,00
$ 63.00
$
$
$
$ 63.00
Each additional inspection: {l) $58.00 $
:~!~i~<<~!~F~~~7~~rA~eLjcA'NT;~p,$~el~~~~~~Jit+j~2;;1~:if;~~)f".':,:.:
(A) Enter subtatal of above fees
(Minimum Permit Fee $58,00)
$ 1:/
$ '77l.
$ I{O-S-
$ Gu?7
J I
(B) Enter 12% surcharge (.12 x [Al)
II I€Ttrci\~alogy Fee (5% of [Al) , '
1 f'tOT"..fJ8MEf a'illMtlr'chliVg.,\P(\.\ llir1ililih '6)';JR K
I\u I HUKiLI:U UI~UI:K I HIt) PI:KIVIII I::' NU J
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
...
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TRANSACTION RECEIPT
811-SPR20111-00683
4324 COLE WAY
,
,
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
perrnitcenter@ci.springfield.or.us
RECORD NO:' 811-SPR2011-00683 DATE: 04/26/2011
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I 224-00000-426102 81.00
821-00000-215004 9.72
_+-:~0-00000-425605 _~==~ 405
, TOTAL DUE: 94.77
l:~AYMENJ TYPE;::y-,pAYClR;CASHIER;;OBOWLSSY',',s;'; ~":>:', i:;,OMMENTS: ""J;"::';~ ,"',: '.;";h'::"AMOlJNTPAID'_.~_:...J
Che~ l~electricseNj~ I 94.77
7478
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RECEIPT NO: 2011000801
[OESCRI"-tION ',y,"','F.\ ;?<;;:; ni.. :~-'_''''
Services 200 amps or less
._ _~!~.!= ~f.~~gon Surcharge (12% of applicable fees)
__ r.ec_hno~o9y'~e_L5'li',~f,~ermil Iota I)
TOTAL PAID:
94.77