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
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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.
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44O-2584-J (91O&JCOM)
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.< ,";', ,.:':,.", >'~%\;~;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