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HomeMy WebLinkAboutPermit Electrical 2011-4-27 08/19/10 THU 16:15 FAX 5417263689 Electrical Permit Ap lication 225 Fifib SlTcct.Sprin;fio:ld, OR 97477oPH(541)726.J7SJ+Fi\X(541)7U-3689 CITY OF SPRINGFIELD III 001 BPRINtiFlI!!iUJ ~c..~ .. \'_ -0"."'-. t. 9 ''"''- ~ .,.,-;TI"<",.o,; L~!~~~j,.... .t73"~~~~" .'~- r ~J~ .......::rh.al;:.::!::>.. ~ ...--......,.~.... . .' ., . OEPARTMEN"i' USE om y Pennit no.: Date: This permit Is issued under OAR 918-309-0000, Permits are nontransferable, Permits expire If work Is mit started within ISO days or issuance or ir work is suspended for 180 days, ' LOCAL' GOVERNMENT,a.PPROVAL:;7 Zoning approval verifled? 0 Ves 0 No - ,; ',C.ArE~ORY':'~:CONSTRUctl0N:;/. o Residential 1 0 Government I 0 Commercial 1f_!,-f.::)J;;joa},$JTJ;ii'INfPRM~l'IOlj\"'At'ton;;O.t;tiTfONt:;~??,: ,; Jobsjwaddress:4~} n-r, r--V ,,0 t:'1=\ City: Y J. ')(). P\(\ 0 I State:(")c;? _ ZIP: Reference: I' -- 10 \ \ TlIXlot.()~ 'Y T " 'OESCRII'TfON. OF WORK" ." '. '.;;i: ::" .'\ 0 n~./ (DIO, nil rI \ , ' . .. PROPERTY.' OWNER Name: '( l' lI/ 1"\ o. :'\\nb\ W . \ ". \\ n T"\ lL. Address: A'" ~h -\-. n (\ V. . \ t"- v City: "(J. y) ('no Stale: 012- ZIP:crA;;"~ Phone: - '), I Fax: . . B-mei!: This installation is being made on residential or farm property owed by me or a member of my immediaTe li1mIly, This properly is not intended for sale, exchange, lease, Or rent. OAR 479.540(1) and 479.560(1). . Signarure: .CONTRAGTQR'INSTALLATlON Busincssname: N'W \o""C'\\A( e.\ec~;(' Address: 1.. \., <.. l.o..-CS-\ 7 "lct. ;:.."IIQ.. City: QiAC€,00 Stale: O~ I ZIP: Ot7'--lO? Phone:5JlF~S 7ZQ7 I Fax:t:y}'<,4.f: 4i(08 E.maiI: CCE lieenstoo.: I&'CjqZ.\ I BCDlioenseno.: c..tg l Signing supervisor'S Iic:ense no,: L..Lj eLl S . Prinl name of signing supervisor: J-eI<?'Y\\J{'Q.\,^6 frl ~ Signature of signing supervisor: ---= _\7 _ v. <-- v .. 44O-2584-J (91O&JCOM) ~ ~ ~ .< ,";', ,.:':,.", >'~%\;~;f'Ee.'$CH~QUl:E':: ,,7;' :';(":;f(':".~?i'.:":. . .' '.' '. . ....,1.. Cost' .Ttilal .i'fuml>er'of:!it;p.;:t!o~spetitlimq ...~, '. .'eo. ..... .... e~sl:" ReJidentlel, per unJ~ servi..lneJuded: 1,000"1, n.orless(4) $134.00 S. ~~~1ditioneJ $00 sq, ft. or portion $ 25.00 S $ 32.00 S $ Limited ..ergy (2) Each manufactured home or modular dwelling .ervlcc or fooder m Servitl,:$ or feeders: installation. plteraliol!. re/ocatton 200 amp' or less (2) I \ $ 81,00 201 to 400 amp' (2) $ 85.00 40110 600 amps (2) $158.00 60110 1,000 .mps (2) $205.00 Over 1,000 amps or volts (2) $4S5,00 Reconncol only (2) $ 53.00 $ 83,00 $~d' . $ $ $ $ $ Temporary servkes or 'kt;dt:rs.l inrlall4tioit alleration, ,.,lccalion 200 amps or les, (2) $ 63.00 $ 201 to 400 amps (2) $ 87.00 S 40 I to 600 amps (2) SUMO $ Over 600 amps or 1,000 volts, see services r feeder, seolion ebove Branch clrcuiu: ne-w. altefotion, ex/f!1UtOIt 1P00r paMttl .. Fee for branch circuits with pu""'... or service or feeder rcc: E.cb branch clrcuil b. Fee for branch circuits without purchase First branc~ circuit (2) . Each additional branch oireuit suo/S f. service or f.eder fee: S 55.00 $ $ 6.00 $ Mlseon.noous r...: sonlico or fe.d.. not iJ cludod Each pump or irrisarlon .irel. (2) S 63,00' S Eaeb sign or ouUine lighting (2) S 63,00 $ ~.1 circuit or e Jimited~nergy panel, alteration, or extension (2) Eacb odditlonelinspoetlon: (I) :\::~:',::f:~~~<f:;~~Y;:.)fr~~hA~~t:;lCMNt:\~ . (A) BeIer ""btotal or above fees (Minimum Permit Foe $58.00) (B) Be\Or 12% surcharge (.12 x [A]) (C) Technology Fee (5% of [A)) TOTAL fees and sutcharges (A thrOB b C): $ 63,00 $ $58,00 $ :.i;;::,::t:'}~.;:, $ ~I.~ $ t1.'1 ~.f')l;... $<../4.'1- SP~It-lGFIE.~ 11&$7 "OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 51 Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00692 4750 FRANKLIN BLVD. SPACE F5 permitcenter@ci.springfield.or.us RECEIPT NO: 2011000809 RECORD NO: 811.SPR2011-00692 DATE: 04/27/2011 ... .....1ii!"'~MO.UNTlQI!jl;~IIlIIltID:,:I:I'..:'1 81.00 9.72 4.05 94.77 lp' ...e.... '5' ""C'''~R''"'I'n. 'T'l'n'N'... ,.",,:./:;lFlHUk,mUi+Ti .... "',, r::LI;..~"...;;:;kj,k:"':""""'''''':'-'']']H'''''''',-,.;" Services 200 amps or less State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) ilij!f011mmD."bli!lilH:;01J~n~~~~IIKUMttIlUlJ~C~CJjJ):N'Jlc~0itjel:llili111lJlltii;ii;;;i",:,',' 224-00000-426102 821-00000-215004 1 00-00000-425605 fI10f11AL DUE: "', ,,". "" '..' "'",..~"~,.:nnii<!mll:III"';""""'" ':- '+'i"'iJlffiffl4fj}!jP&mni_".lilriti(1Pllj11J~..""F"",*,,""H""~'-"lIil"'l<;i'~;,'?;n PAYMENT..TYPE+":"" 111'PAYQWiF"ICASHIER: [HOPPER ~:I':@F:J'I'iICOMMENJS, llIiliiiUl!lii!h Credit Card NEW REYNOLDS ELECTRIC INC 045140 W;tl)jililjbmiillllilPnS1ftjlnU?A' '{M OU':' NJI~A' "ID"~_n;m!ruF!I~hl'il ,;,,;,\..::',y,"""",..'<.f .. .."'",,^JJ,':i,, .. ':t\ .. .. ~;;;jbir::1:/i," 94.77 JOTAL PAID: 94.77