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HomeMy WebLinkAboutPermit Electrical 2011-5-2 ^ '1& ~.~ Electrical Permit Application IYmlIWFiffi70];~'~::ff~rt~'~0Ei\\lltlTWJmm~~';I!lf~rJ~11jfi;j 1f;'?f€~f(t~4~t~,f3'11f. ~~~~\J'~~~~fD; i-.l~Yik~::~~."l~'~r'~'.:S~:'1:id:t~'_~chm:;.:~,";Ni1a211 22S Fifth Street .Springfield, OR 97477. PH(541)726.3753. FAX(S41)726-3689 ~PFlINGI'IIZLD DEPARTMENT USE ONLY . -5Pf'2-2b/!-() 7'd-9 Permit no.: ~, Date: This permit is issued under OAR 918~309-0000. Permits lll'C nontransferable. Permits expire ifworf{ is not started within 180 days of issuance or if work is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoning approval verified? 0 Yes 0 No CATEGORY OF CONSTRUCTION D Residential 0 Government IZJ Commercial JOB SITE INFORMATION AND LOCATION Job site address: 162 S 15 th ZIP: 97477 Subdivision: Service Name: Cily: y- S;l ZIP: Phone: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate fomily, This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signahlre: CONTRACTOR INSTALLATION Business name: Olsson Industrial Electric Address: 1919 Laura Street City: Springfield Phone:541 747 8460 ZIP: 97477 747 4846 E-mail: CCB license no.: 63473 BCD license no.: 20 - 2 41 C Signing supervisor's license no.: 3334 S Print name of signing supervisor: Doug S~gnaturc of signing supervisor: ^'TTENTION' Oregon law requires you.t.o . " . b the Oregon Utility follow rules adopted Ye rules are set forth Notification Center. ThhOS hOAR 952-001- . OAR 952-001-0010 t roug JJ In btain copies of the rules by 0090. You may 0 Note' the telephone calling the center. ( '.. N tification \ 440r\tJl~,-Iti'l!q81<:li'>.l\1e Oregon Utility 0 .\"..'1 Center is 1_800-332-2344). ~~\Y ~ FEE SCHEDULE Number of inspections per item () Qty. Cost Total ea. cost Residential, per uuit, service included: 1,000 sq. ft, or less (4) $134.00 $ Each additional 500 sq. ft. 01' portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufnctured home or modular S 63.00 $ dwelling service or feeder (2) Services 0" feeders: ills/ollalioil, ollc/'{//I'OIl, reloC(/tioll 200 amps or less (2) 1 $ 81.00 $ 81 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 2,000 amps or volts (2) $469.00 $ Reconnect only (2) $ 63.00 $ Temporary sci"viccs 01' fcce]crs: installalion, allemtioll, relocatioll 200 amps or less (2) $ 63.00 $ 201 to 400 amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch cil'cuits: ne\l\ altem/ion, exfellsioll per pallel a. Fee for branch circuits with purchase of a service or feeder fee: Ench bnmch circuit 7 $ 6.00 $ 42 b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) $ 55.00 $ Each additional branch circuit I $ 6.00 $ MiscellaneOllS fees: service orfeerler not il/clllded Each pump or inigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited-energy panel; $ 63.00 $ alteration, or extension (2) Each additional inspection: (I) $58.00 $ APPLICANT USE (A) En(crsublotal of above fees $ (Minimum Permit Fce $58.00) 123 (B) Enler 12% surcharge (.12 x [AD $ 14.76 (C) Technology Fee (5% of[A]) S 6.1' TOTAL fees and surcharges (A througl1 C): $143.91 NOTICE: THE WORK THIS PERMIT SHNAOLE~ ~~~R~~~MIT IS NOT AUTHORIZED U FOR COMMENCED OR IS ABANDONED ANY 180 DAY PERIOD. ..".\ , SP~~N~~L~ .'\~EGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth SI Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00729 162 S15TH ST permilcenter@ci.springfield.or.us RECEIPT NO: 2011000854 lbtscRllmON,":i",i,':' :' Branch circuits with service or feeder each circuit CASHIER: NMACHADO RECORD NO: 811-SPR2011-00729 DATE: 0510212011 '; ,.' ,,'i;~,;'ACCOLJi'KCODE~ ,<I, ". AMOUNT-DUE 224-00000-426102 42.00 224-00000-426102 81.00 821-00000-215004 14.76 100-00000-425605 6.15 TOTAL DUE: 143.91 ":~ AMOUNT PAID 143.91 Services 200 amps or less _ .__~ta~<;. of.9.~go-"_:>LI'.:harge (12% of applicable fees) __ Tec~-""-lcJg~J~ (5%_0.!,~rmit total) LPAY!'/l.E~tLlY.PE~PAr.QR Check D2H LLC 058413 CoMMEI',IIS . TOTAL PAID: 143.91