HomeMy WebLinkAboutPermit Electrical 2011-5-5
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
S, P RON G, ,FIELD ~.. .,
~ il.A~~~
~ 6i., <(:
'ieR~4. ..."
'DEP~RTMENT USE ONLY
Sf./l'LOf{-OC> 7b'l
Penn It no.:
Date: S-S - (
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
"',' 'L.:OC~VGOVERNMENT<ApPROVAE" ,i"\'f'i^':'''i
Zoning approval verified? 0 Yes 0 No
:;./'c" .JCArEGORY.(Of,':CONSTRUCTION~:\" t,o""'..
.M Residential I 0 Government 1 0 Commercial
S"E;{;,JOB. SITE~INFORMATIONIANDr.'LQCA:Y;ION;:;r"W:. :
Job s)tpddress: 'W t:., G1 f/) '0 -f Y '( 'f ~
City:; 0, /1 ' '-./ 1 State: n V I ZIP:0' - J Ti
Referen~e: 7os:SLZ> Taxlot.:/;>'~U\J
" , DESCRIPTION. OF WORK";""" :,.','i!';.'i'"
L'.{JY\I,'d V-p()o.~-r /'1 f)/A,,/> JJl
V \ V" 0 l I""'" / v I~\..J f VIU l
...- ^ 'PR pPEijII'Y: OWNER ' ' .
Name: -c IV IV ~IL I ~"i)&~
Address: 52- $" / f-I~Lbw ~
City: St>~"'" I State: t:>(l I ZIP:9 7f.(77
Phone:
E-mail:
Fax:
This installation is being made on residential or farm property
owned by me or a member ofrny immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
'479.540(1) and 479.560(1).
Signature: /"
CON rMCTOR IN
) vr-f
Address: I~O )(J'-/., (yc, 7 I "
City: Vv;4/ +r ry, I fA State: L yf I ZIP:(", I .f. /"
Phone: 0Lf -1 1-- - 1. \.11 Fax: rll U I I) 4 /
E-mail: ( / 0 v / 0 (I /
CCB license no.: ( /) (J l/-lJ-( nl BCD license no.:diJ CJ-LtJ ( ,
Signing supervis6r's license no.: 4- -, A I ,,-:> /'\
Print name of signing supervisor: OJ'oj, 'i .
Signature .. l"Jw.'of~n I, re~ u 'NM4~u ti ) \/\l
follow rules adOP~~bY 1e'l I ~
Notification Center. os~ rules are set forth
In OAR 952-001-0010 t ugh OAR 952,001.
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800,332-2344). ~ \
\~~~o/
~
Business nij1(le:
/'\
AllAitLON ('0 .
j ) Y ()-.)
440,2584-J (9/08/COM)
F';:~~~ijl:;':%;:~::,t~\?i;~tr%;;{r~;-':'ti FEE_;j:SCH EJ>.U tlE:~~'i.t"f~~lil(~~f.'i~L..;i~:icJ~~~;;
. N u ~ qer' o.finspecti~ris pe~it~~i ( ) ,'",; Qty.; ~~~, ~~~I
Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
~welling service or feeder (2)
Services or feeders: installation, alteration, relocation
~
$ /61.-
$
$
$
$
$
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 amps (2)
60 I to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
'j-. $ 81.00
$ 95,00
$158.00
$205.00
$469.00
$ 63.00
Temporary services or feeders: installation, alteration; relocation
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a. Fee for bra~ch circuits with purchase of a service or feeder fee:
Each branch circuit
$ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder ':lot included
Each pump or irrigation circle (2)
$ 63.00 $
$ 63.00 $
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
kach additional inspection: (I) $58.00 $
~~~~-4~'~?i!~~~;~lA~f!.tlCI\Nt,o~lis_E\." '::J.:"~~f.i~;;~~;rJ{;':~-:/;.f;'2. ;.';
$ 63.00
$
(A) Enter subtotal of above fees
$)17
(Minimum Permit Fee $58,00) b,t..--
~)J!)Je..l)% surcharge (.12 x [AD . " '. ,. $ I~""
(C)J.~c l1~Ii!',I,:eEo{li't(~,\f Wbtor: . WehR\( $ 8"0
t~W~1-:fl'F~~'l<\'''.'h ~",";;~~ih.rl'll!1'1R5 MOT $/ P, r; S't
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
ii~~:~
OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811.SPR2011.00764
1459 B ST
permitcenler@ci.springfield.or.us
RECEIPT NO: 2011000892
lDESC:RI~TION ., ":;' "',;,(f;'~ '.'
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 611.SPR2011.00764
i.". ,,' . 'Wi:A'C:C:OUNT.C:.ODE <' ..:Of "",
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
DATE: 05/05/2011
?'AMO.UNJ.D.UE,
162.00
19.44
8.10
169,54
AMOUNT PAID
169.54
U.P-YME;tf!' TYI'E
Credit Card
01511d
'PAYOR CASHIER: DBDlVeSBY 'f: 'c COMMI:~IS
BURRELL BROS ENTERPRISES
INC
TOTAL PAID:
169,54