HomeMy WebLinkAboutPermit Electrical 2011-5-16
fl~ctrical Permit Application
'CITYOF'SPRrNGElELil:'OREGON
- , '.. ~ ~ }. ~ . ~'~ _ .t!- . .~ T K"': , 'Il, .. "
225 Fifth Streett Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726-3689
DEPARTMENT USE ONLY
Permit no.:.S> ~1/-()az.3'J.
Date:
This permit is issued under OAR 918-309-0000. Permits are nont~ansferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
CONTRACTOR INSTAllATION
Business name: e A.STS/Dc El ELTf/.Je
Address: ~S:lS'5 BOS,C/lG-E LN.
City: 5 P f CD State: 0 R. ZIP: '17 '-I n
Phone: - 7l{/-1'{'19 Fax: -731:,' y%O
E-mail: RIC KU,S75/i)E (Ql Y Ai-/66 , (0 tv!
CCBlicenseno.: }lJ/IO BCD license no.: 10 -VO!;c
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Signature of signing supervisor: I
ATTENTION: Oregon law reql ,reo uU.',
follow rules adopted by the Oregon UtIlity
Notification Center. Those ru~e~~~e 9s;~_fg~~~
In OAR 952-001-0010 throug b
0090. You may obtain copies of the ruies y
calling the center. (Not~;.i~e ~e~~~~~~~n NOne
number for the Oregon 111344) THIS P
Center is 1-800-332- ~~~.~ ~~~HS
. <:t.:J" ~~ ANY 180 DAY PERIOD.
440-2584-J (9/08/COM) \} .
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
esidential
City:
Reference:
DESCRIPTION OF WORK
(:rBt- L:- "" n+...
ZIP:' 7'0
City:
Phone:
E-mail:
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:
Signing supervisor's license no.:
Print name of signing superVisor:
/( ndj-
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
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: imtallation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
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 $
401 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 branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2) I $ 55.00 $ Sy
Each additional branch circuit I $ 6.00 $ I~
Miscellaneous fees: service or feeder not included
Eacb pump or irrigation 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) Enter subtotal of above fees $ b(
(Minimum Permit Fee $58.00)"
" .,...,'......,..'-
~j;:n<;~B'?(o e~4l[t>>^'''OI/ $ -pZ
E, 'J..'UW~wfE;;'"7 . 1<:: W"lT $ 36.>
,I,~""hll' ~ .
.';:.-;:--:~.if'e.sQn<fl' s~. . $,,3
E I . ~ s sur ~;q.rough.C):
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OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.u$
811-SPR2011-00233
918 66TH ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000981 RECORD NO: 811.SPR2011.00233 DATE: 05/16/2011
ibESCRII~.l]ON':L...::'::!'.Lci:'; "..:'::t;,.,;,'i;;;":' ~ ::;::',"\'~ " ;;):C.CO.UN:f.CODE>.\" .Ie::'" ',:. AMOUNtbuE/
Branch circuits with service or feeder each circuit 224-00000-426102 6.00
Branch circuits without service or feeder - 1st circuit 224-00000-426102 55.00
State of Oregon Surcharge (12% of applicable fees) 821.00000.215004 7.32
Technology fee (5% of permit total) 100.00000.425605 3.05
TOTAL DUE: 71.37
L~""Y:II1ENLTIEg:,.f:.,.' R~"Q~~.~HIER(DBowCSBy.\',?;;,;r-i[ ;<iQMI'I/1EN1r~::(,:"r-\'..'::'. "~..' ..l\MOUNT::P,AI[)"'C.i .~
Credit Card EASTSIDE ELECTRIC INC 71.37
075098
TOTAL PAID:
71.37