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HomeMy WebLinkAboutPermit Electrical 2011-5-9 EJedrical Permit Application 225 Fifth Streett Springfield, OR 9747HPH(541)726-3753tFAX(541)726-3689 DEPARTMENT USE ONLY - Permf~7..0f(-CO 7g0 Date: 5-'r-l ( This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80 days of issuance or if work is suspended for 180 days. 'l:OC~L; GOVERNMENTAPPR0VAL~''''-- Zoning approval verified? R! Yes D No <C~TEGORy.iOF :CONSTRUCTION::;e, o Residential .0 Government Commercial ~~:jtO.I3;;;SIT:Ei:INFQRMA;tloilli!~NI:l;'IIO:C:AT:fON(Jlj1;i:;i;;r! Job site address: .30'.2.. 5:- City: ";-, Name: Address' This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1). Signature: Business name: City: Phone: B-mail: Signature of signing supervise . ON' I b'!tlW ese ~1T€.N\\es adopt' \'lOse lilieS ~~ 9S'2.-GG~- \0\10'1'1 ~~on centelo'. 0 t\'l101l9\'1 01 \\'Ie lilieS b'! tiliC"'" 0\-0' nies 0 \'lone tlo .a 952.0 btain co,.. . tlie tele? \iol\. \n 01"" (1'0.'1 0 ~NO\e. \,<o\\I\Ca.." 0090i\,;~~\'Ie cent~~e90n \J~~:h'4). '~, \. . ca \oel 101 \\'Ie. s ~ _BOO-3 o?-v {) ..~ ~.' '$/ .~ 440-2584-J (9/08/COM) ,~' .,: ' : ':'-,;}~.~,,~~;;';",\<~{f;ii;;:~t,"~:;?-,~: t,E E.;~ S CH E"D.l2J ~E: ;!:~.'''l}'f~:';~i~;(?;:}~';j:;l~~~~W~~~~t~~~ -' . Cost. Total Nu~~er' 0.( inspe~tio~s ~~r..it~.~-(,). Qty. .. ea; ~ost: '.. 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 $ dwelling service or feeder (2) Services or feeders: instal/C!tion, alteration, relocation 200 amps or less (2) $ 81.00 $ 20 I to 400 amps (2) $ 95.00 . $ 40 I to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $459.00 $ Reconnect only (2)' $ 63.00 $ Temporary services or feeders: installation. alteration, relocation 200 amps or less (2) $ 63.00 $ 201 to 400 amps (2) $ 87.00 $ 40 I to 600 amps (2) $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 braI")ch circuits with purchase of a se'rvice 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) / $ 55.00 $ S(' Each additional branch circuit .6 $ 6.00 $ :SO Miscellaneous fees: service or feeder ':lot included . Each pump or irrigation circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signal circuit or a limited~eriergy panel, $ 63.00' !",,'f- alteration, or extension (2) .._.,l .. Each additional inspection: (1) . ~~~W ~\)\ , ..,",..'..,."'"..":',,..h'.....'..ARP'C "'Nt..~'t:\":~~\\".J --. ::w1i_,~'/\~"-:,::/..J'~~~~t~~}:?~~~.. ,,~,1I -:A ;' :;?U ,,_,..' .._ ->-,,i ,...,:.;'.:-<~.: (A) Enter subtotal o~.bove fee~~\.\. '\:.~\\\S <(~~'t-\) ~ .. (MinimumJl.(~IF1o"e @l:,(\'t-"-", t>..~\) $, f? S- (B) Enter 12'J; ;UW'a'r~~(1t)} ~ \'0:;' $ /0 ~C> ,. , (C) Technolog~W5i~I'l't'fA~ -J'V't-W\J' $ '1= "'WO~ g~n '19'1. TOTAL rees aQft.suro ~ (A through C):. $ f>-.\'< ' . SPRIN.G. FIEl;1i .-- .: i/t1J :,;<:...,\ OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 5t Springfield,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-00780 302 SHELLEY ST permilcenter@ci.springfield.or.uS RECEIPT NO: 2011000908 RECORD NO: 811-SPR2011-00780 [DESCRIP.TION .L: .;.,. _ .:...;T~.,. ,. I;\C.CQUr'l:tC.ODE.. Branch circuits with service or feeder each circuit 224-00000-426102 Branch circuits without service or feeder -1st circuit 224-00000-426102 ---------...---- State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 Technology fee (5% of permit total) 100-00000-425605 TOTAL DUE: DATE: 05/09/2011 I;\MOUNLDUE 30.00 55.00 10.20 4.25 99.45 . AMOUNT PAID' 99.45 ,) L~ YII!E!lI iY~!'....c.::.-P-"'Y_O_R CASHIER: "BOWLSSV" Check JB ELECTRIC INC 122012 9.o.II!.M!'JiIS ,- TOTAL PAID: 99.45