HomeMy WebLinkAboutPermit Electrical 2011-5-12
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Electrical Permit A
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225 Fifth Street. Springfield, OR 97477. PI-I(541)726-3753. FAX(541)726-J689
DEPARTMENT USE ONLY
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~ Permit no. s/I- 60 '30S
Date: 5
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.
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
o Residential 0 Government lB.commercial
JOB SITE INFORMATIOIII AND lOCATION
Job site ~dlJ'SS:~ J If 1 ~ '\.T U \j \.
City: K r I Statel f'\ Z~ '-I
Reference: 703. I S I.{ D Taxlo!.: OI:lSOO
DESCRIPTJON OF WORK
I ''7--1- f\..1 1 / E-H'\. >- / l--.L '\.. ~I Y \
-t F-'J \ "::l l- \. \I' T. I .
. PROPERTY OW E
Name: \-J ~ I J {:-'J ./
Addressl, L \ 1-:'-1 "- T
City~f" "--,--,V' State: ,.)~ ZIP:
Phone: - - I Fax: - -
E-mail:
FEE SCHEDULE
Number ofinspectio~s per item () Qty. Cost Total
ea. cost
Residedtial, per unit, service included:
1,000 sq. [1. or less (4) $134.00 $
:-to Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited ener&'Y (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: ins/allation, alteration. relocation
200 amps or less (2)
$ 81.00 $
S 95.00 $
$158.00 $
$205.00 $
$469.00 $
$ 63.00 $
20 I to 400 amps (2)
I h 11......, .40 I to 600 amps (2)
\).. I Y f6.0 I to 1,000 amps (2)
I '-f Over 1,000 amps or volts (2)
Reconnect only (2)
CONTRACTOR INSTALLATION
Business name: )( V ) J. +-'-. ^ J II H 'r-
Address:I"'""' '-, . L 'V ) ~
City:~1 ~ /) State:l Jr'\ zIfr: Ilor
Phont!fj .1!- . I r r Fax~ .-(Y .rJ
E-mail: LOe..M A :J'Y). 1. \'"\ :JL
CCB license no.: ~7 ,1-;;;l. BCD license no.1.lJ .l..(' ...
Signing supervisor's license no.: '-I '-t l hi - A.-J
Print name of signing supervisor;:'- ~ -, " )J y f\
Signature of signing supervis~ -1Jl:;.:.. v v
ATTENTION: Oregon law requires you t6
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by -{ NO (Il" ".tcr 12% surcharge (12 x [A])',~,.',,;;;o""
calling the center. (Note: the telephone 1\ ;"v' (. ogy,F"",{5' ,n",: I~ TI-lF WnR~
number for the Oregon Utility Notification V\ THI Toe ,,';"L~~;;.i~=_::"'~__
Center is 1-800-332-2344). ~,\ AU TI'i (),"'/f'l'1~rrY~r"f.fI'l;e ~OOT "
S \,J COMMENCED OR IS ABANDONED FOR J.'<''''
440-2584,) (9/08/COM) . ANY 180 DAY PERIOD. '
'*
This installation is being made on residential or fann 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:
Temporary services or feeders: installation. altera/ion. 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 branch 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) $ 55.00
"C!JCl( a<\clitional branch circuit $ 6.00
pt.ttscellaneous fees: service or feeder not included
$
S
Each pump or irrigation circle (2)
\,1 llac_~~ut1ine lighting (2)
S 63.00 $
$ 63.00 $
$ 63.00 Sll;~ ()
$58.00 $
Signal circuit or a limited-energy panel, I
alteration, or extension (2)
Each additional inspection: (1)
APPLICANT USE
1, (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
S{p2~
ft.'?-/"
$ .F?
$-1 ~ ~
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~SP~:~GFIELD
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- - ;,'.. ~ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00805
400 INTERNATIONAL WAY
permitcenler@ci.springfield.or,us
RECEIPT NO: 2011000928 RECORD NO: 811-SPR2011-00805 DATE: 05/12/2011
!DESCRIP.JION .. :,::x'?'T;,'~]f':'.#"ff~:~A::/,: ,J.'. ~_ ~,,'nt:""',AC;COUNJ~CODE7,~'.;-,": :;:~, ,;, AIIIIQUNJJiUE] ,'"
Fire Alarm 224-00000-426102 63,00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 7,56
Technology fee (5% of permit total) 100-00000-425605 3.15
TOTAL DUE: 73,71
f' ,PAy'MENtWPE#1:-:~':'P-AY6R ~e:;cAsfIlERTDBOWcSBy~"{":~4;':!f.'::'7CC1.MMJ",tj'ts#iF~'<;'f~~:':"'";7AMOUNT;PAI[)' ,,:',";','::.5 '1
Check OMLlD & SWINNEY FIRE 73.71
41815 PROTECTION & SECURITY INC
TOTAL PAID:
73.71