HomeMy WebLinkAboutPermit Electrical 2011-4-27
08/19/10 THU 16:15 FAX 5417263689
225 Fiftb 5tTccl>Spri.~ndd, OR 97477> PH(S41)716.J7S3tFAX(.41)7U-361l9
CITY OF SPRINGFIELD
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DEPARTMENT USE ONt Y
Pennit no,:
Dale:
This permit is issued under OAR 918-309..0000. Penults are nontraosferable. Penults expire 11 work Is nlit started within ISO
days of issuance or if work is suspended for 180 days. .
Limited ene'llY (2)
Each manufucturod home or modu).,.
dwelling servlcc or feo:der (2)
S....im or feeders: imlallgljon. o/Ieralion relocation
200 amp. or Jeos (2) I S 81.00 $1",1
'PROPERT( OWNER :,' . 201 to 400 amp. (2) $ 9UO S
Name: YO\ y, --~ Ur ,\, \'t" \h ~ 401 10 600 amp. (2) $188,00 $
Address: ') W" f) (\, ,~1"1. \J 601101,000 amp. (2) $205,00 $
City: f mf riP I State:('/;) I ZIP: U' ~()' Over 1,000 amps or vohs (2) $469.0D 5
Ph 'I Reconnect onh. (2) S 83.00 S
one: . '. Fax: . . '1
E-mail: Temporary servic.. or k<:d.r., 1"-1loll4tior- alterariM, relocation
This installation is being made on residential or furm property 200 amps or less (2) $ 63.00 S
oWlled by me or a member of my immediate flunlly. This 201 to 400 amps (2) S 87.00 S
property Is not intended for sale, exch8l1ge, lease, or rent. OAR
479.540(1) and 479.560(1).. 40110 600 smp. (2) 5126.00 5
Signature: Over 600 amps or 1,000 volts, See Sel'Vices r feeders oection lIbove
:::CONTRACT-QR . INSTALLATION: Braneh .Ir.ulul new. alterarion, lX/omionp.. pan./
Business name: AV'u.) {'P, ,,... o\A5 p\ er.lct: : (' .. Foe for brMch circuits with purthll# of wvles 01 feeder r.e;
Address: 1.. \ 7.5 wQ ,;:,. 7 ",,<J.. k'i 0 Each hrMch olrouit I S 8.00 $
City: e uCJ ~"Irl.. I Stille: OQ ZIP: 0.. 7l/0"L b. Fee for branch clrcui15 without pureh... fa servlc. or feedcrf..:
Phone:<:.J-jl"~t. 72. q", I Fax:9-i\.,j:jC, /J () ^ 0 Pirst branch circuit (2) $ 55.00 S
E.mail: . Each additional brnnch airellit $ 6.00 5
CCB license no.: I ~ lJ q 21 I BCD lioense no.: C 4 .5.,- Mis..llancOu, fees: $trvlae cr fteder n011l ~ludod
Simln.. sUDervisor's license no.: .s Lj oLj .s Each pump or irriprlonoiroJe (2) S 63.00' $
Print nll1lle of Sil!llDlg .upervisor: ~ {flfh ~, ('pv ",:, id. (" ~ sign or outlin~ li~ting (2) S 63.00 $
Signo1ure o!signing supervisor' ~ ["...' v alclreull or a h!"lled-cnergy ponel, $ 83.00 $
. a1torauon, or ..te.Ulon (2)
E..h edditionolinspet:tlon: (I)
ii'::::i''iY\;,;~3J''.,'fUi;:iAP',etICI1i~:t'M
(A) BDter subtotal nfabove ree,
(Minimum Permit Fee $58.00)
LoeAl G()VERNME~T .APPROVAl;' ,." .,.
Zoning approval veri fled? 0 Yea 0 No
.. :, 'd',cATEGOR~:"O":CONS"RUC1ION:"" , .
o Residential I 0 Government I 0 Commercial
~~.';i:::.i::J()$;f~)TJ::;'INFPRMfiT:I()\jI,"AWDi':t.O~:ArroN.~;;~!;:....".
Job site address:A- \ ~ n.. un ~ \ \\f'\ 1-:::-
City: PI )("1 ?,(\p I State:l)lS- ZIP:
Reference: 1M, y,..... \ I T~lot.:()?:>-c:jj)
'DESCRIPTION.OF WORK ~". :.,' .:;.'.;: .
r \?'r ffi rr. 9.. n """("\')\re-
\X)\L-
l.~o../
JA'Q.."\'\\
\);\
44O-2584.J (9IOSlCOM)
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. .' " .., ,:',' .... '. :...rJ,' Cost. T:otal"
,l'lu~be~nrlnsp~~!O~~,perlte,mO' ';~' :. .'m. ..... ".' i;l!st '"
Residential, per unl~ St'rvi~e included:
1,000 "I. It or less (4)
Each addition91 500 sq. II or portion
the.reof
$134.00
5.
5
$ 25.00
S 32.00
$
S 53.00
5
(B) Enter 12% surcharge (.12 x [Al)
(C) Technology Fee (6% or [A})
TOTAL ree, and surcharges (A tbrou~h C):
$88.00 $
. ..:');~:.:,:. iir.' ,~;s;.:."
5P>' .ct
SQ.Y_
$ ",\~n ~
Q<\:y
SP~RINGFIEL.~
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. .," OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
WWW.ci.springfield.or.us
811-SPR2011-00690
4750 FRANKLIN BLVD. SPACE F7
permitcenter@ci.springfield.or.us
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j'r>{' ..) ~_:."'i>"-i+j L-Jl',)T\nl)nlJif."'jiliAC~C_0"l:JNrn..C~0:mE"!j;hrH" '/,
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
DATE: 04/27/2011
"-"II'II"'''''''P.:Ml5j'jN:fitjJ!iE~iiPJli1ilm.,III;''II'1
8100
9.72
4.05
94.77
RECEIPT NO: 2011000810
lbESCRII~inQNI,lill' .' .v
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-00690
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PAYMENT:'mYPEll\:u'1i,:i ii)'PAYOR CASHIER:' LHOPF':ERm" j- jt'~'\jn1;1i;',;.COMMENTS }f:''',h, "I, y,hs'UL ,LJ;!j:i.hji1L gilrUJj<", ",n,:" " ,;,;l;n ,~, ,~Jl!1tR1!;;.ru&i~';:!iI""
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Credit Card NEW REYNOLDS ELECTRIC INC 94.77
082630
TOTAL PAID:
94.77