HomeMy WebLinkAboutPermit Electrical 2011-4-27
08/19/10 THU 16:15 FAX 5417263689
Electrical Permit Ap lication
225 Fiflb Str<<'.Sprie~n..d, OR 974'77. PH(S41)716.J75H FAX(S41)7:l6,l689
CITY OF SPRINGFIELD
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. DEPARTMENrUSEONlY
Date:
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This permit Is issucd under OAR 918-309-0000. Permits are nontransferable. Permits expire If work Is n~t started within 180
d.y. of Issu.nce or if work Is suspended for 180 d.y..
taeAl. GOVERNMEIHAPPROVAI.;;";7" . ,.
Zoning approval verified? 0 Yes 0 No
- .. .',c:Al'EGORlt:tIF:CQNS1'RUCtfON';....
o Residential 1 0 Oovcrnment I 0 CODlmercial
1f,..,!;:,'..i;'JO$1.$ITEi'INFORM4"IQIj\:'At'40!"{tiOt){TIONt:,~::;.;.......,
;ob~jte.d~.:..v \.:'.'1; D.ll.' \'U\~ Cl,..,
City: .,.., 'Y P--r\-~ I Slllte: N _ ZIP:
Reference: \ '-hb~"jo \ \ Taxlol.f ro
'. 'OE$CRfPTION. OF WQRK;' ..... .,,:,:.:.
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Name: Y\~lP~R~~ER~~~\';,.'\II.~\~
Address:A-"'\ ....,,") 1f( ~lr\ \ \.10 ~
City: t( 1. 'y 11' 1 V" StateO lL mQ I~{ 1'"
Phone: . " I Fax: . .
E-m.il:
Thi. installation is being made on residenti.l or fmm property
oWlled by me or a member of my immediate family. Thi,
property Is not intended for sale, exchange, lease, or rent. OAR
479.S40(1) and 479.560(1). .
Signature:
.CONTRACTQR . INS! ALLATlON:
Business name:
Address:
City:
Phone:
Slllte:
I Fax:
I ZIP:
E-mail:
CCB license no,: I BCD license DO.:
Signing supervisor'S license no.:
Print name of sillnulg supervisor:
Signature of signing supervisory;:::::)
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".:.' .7,.::;.:.,....>;'~\',;\:/;.'f'EI:.:"CH~QUI;:E::: .~;;. i'i',:;> :1.r:~t{...:;.
.io!u~be(Df!D.j,e~~spet~(). QiIy, .. ~" .... ". .~rs:~':.
Rt.!identlat, per unit; servi~t included:
l,ooOsq.lI.orles.(4) $13'.00 $.
Each additionBl $00 "l. ft. or pertion S 25.00 $
thereof
Limited eoergy (2) $ 32.00 S
Each manufactured home Of modular $ 63.00 S
dwelling ,ervlce or fe<:der OJ Strv.cC$ or feeders: instaJlaUOI1, "Iteration. re/ocarion
200 amps or Ie,s (2) \ $ 81.00 so,U L/
20 I to 400 amps (2) S 95.00 $.....
40110 600 &lips (2) $168.00 S
60 I to 1.000 amp. (2) S205.oo S
Over 1,000 amps or volts (2). $469.00 $
Reconeeol only (2) $ 63.00 S
TempDrary services or k<<Iettl.1 ifl3lallatiOi'- alU!I'Dtion, relocation.
200 amps or less (2) S a3.00 $
201 to 400 IlllIpS (2) $ 67.00 $
40110 600 amps (2) $126.00 $
Ovcr600 amps or 1,000 volts. see service. r fUllers scotion above
Branch clrculul new, tJlt,rQrion, exlansion ~C!r pa~f!t
.. Foe for branch clrcults with purchase or. mvlce or iCed.r fcc:
Each branoh circuit $ 6.00 I $
b. Fee for branch circuit> without purchase f a service or fceder ree:
First branch circuli (2) S 55.00 S
. Each additional bnlncl1 circuit $ 6.00 $
Miscellaneous fees: $O/"VI.. or f..der nol iI cl.a.d
Each pump or lnigarion circle (2) $ 63.00' S
llaeh sign or outline lighting (2) $ 63.00 S
Signal eircuit or .limiled-cnergy panel,
all"",tion, or extension (2)
Eacb additieeanespectlee: (I) $68.00 S
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(A) Snter subtotal ofabovefee, ,r,: tJl
(Minimum PcrmitF.eS58.00) $nl.
(B)En~ 12% surcbarge (.Ilx [A]) $ O.l'J..
(e) Technology Fee (5% of! AD S '\-'. ct. )
TOTAL fees and .urcbarges (A throD . C): $ OtAc..1 1
$ 83.00
$
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield, OR 97477
541-726-3753
WNW.ci.springfield.or.us
811-SPR2011-00693
4750 FRANKLIN BLVD. SPACE F6
permitcenter@cLspringfield.or.us
RECEIPT NO: 2011000808
RECORD NO: 811-SPR2011-00693
DATE: 04/27/2011
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224-00000-426102 81.00
821-00000-215004 9.72
100-00000-425605 4.05
TOTAL DUE: 94.77
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PAYME~J'E, ,": ,:-;':' PAYOR -"'CASHIER:.LHOPP.ER.. .. '.c'.:....' J.l~!COMMENTS!~j;lUhtlEiWnilll)1jmU\i1mm!mil111tlIi111'111i1mmL__ .,n :',- ~lfr;:\" .. '~iEmnfil;1hUH;:h;.
Credit Card NEW REYNOLDS ELECTRIC INC 94.77
tD~S:CRIP~TJON i. ,;!!;,ii*,WJKlilllllllllilllllliifillifi,!lli.lli,lli ."
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
017830
TOTAL PAID:
94.77