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HomeMy WebLinkAboutPermit Electrical 2011-5-19 . _....~ - ." ~. . . Electrical Permit Al!.plication I mw <lDW ~~lJiTI~llJID;,~ 225 Fiftb Street+Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689 I~ DEPARTMENT USE O'NL Y SB \ \ . -0\ 0 Permit no.: 0' Date: 5 - ) OJ - ( This permit is issued under OAR 918-309-0000. Permits are noutrausferahle. Permits expire if work is uot started within 180 days of issuance or if work is suspended for 180 days. . N ir Q LOCAL GOVERNMENT APPROVAL . FEE SCHEDULE Zoning approval verified? DYes DNo Number of inspections per item () Qty. Cost Total CATEGORY OF CONSTRUCTION ea. cost o Rcsidential o Government I WCommercial Residential, per unit, sen'ice included: JOB SITE INFORMATION AND LOCATION 1,000 sq. ft. or less (4) $134.00 $ Job site address: -::J..Or:;:: r: lam ''''~'' N.1f .. Each additional 500 sq. ft. or portion $ 25.00 $ thereof City: 9SfR\.l6f/PiLi I Stat~: DR I ZIP'Ti-L/7f".1- Limited energy (2) $ 32.00 $ Reference:/ED /DRDi -F"'l)'/i,r{J",,~ I Taxlot.: Each manufactured home or modular $ 63.00 $ DESCRIPTION OF WORK dwelling service or feeder (2) Rpl{) LAi!:. Y7 - .Ll-" elecfr-,YI.J $RJI!lU, Services or feeders: installation, alteration, relocation \ fl. D!) 1l.. ~L ~ \-..1 t:::X:\I)- rY-J 200 amps or less (2) ). $ 81.00 $jt.:) PROPERTY OWNER 201 to 400 amps (2) $ 95,00 $ Name: <;;DrI,.,,<;j\elJ <:d/J6/ flMflc+ I q 401 to 600 amps (2) $158.00 $ Address: 1<t'9D if). I'll) S+-o 601 to 1,000 amps (2) $205.00 $ City: Sn('j ,.)"~drl I State: OR 'TzIP: Q1'/ro Over 1,000 amps or volts (2) $469,00 $ PhoneSII.. ~~lf. ': L n::::- I Fax: - .. Reconnect only (2) $ 63,00 $ E..mail: Temporary sen'ices or feeders: installation, alteration, relocation This installation is being made on residential or farm property 200 amps or less (2) $ 63.00 $ owned by me or a member of my immediate family, This 201 to 400 amps (2) $ 87.00 $ property is not intended for sale, exchange, lease, or rent. OAR 479,540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $ Signature: Over 600 amps or 1,000 volts, see services or feeders section above CONTRACTOR INSTALLATION. Branch circuits: new, alteration, extension per panel Business name: Ne.., ~e" ..ul1ct1 f:.!~ It......... a Fee for branch circuits with purchase of a service or feeder fee: Address: :l \ '1 ~ l...> .,.,..:", ~......' Each branch circuit 15 '$ 6.00 I $Ig~, City: ~,,~~ I State: ~ j1... I ZIP: '11 'f6?- b. Fee for branch circuits without purchase of a service or feeder fee: Phone: 54/ ..3'0- 7 t. .. 7 I Fax:54f ..3.'1!;" '(Il,ol/l First branch circuit (2) $ 55.00 $ E-mail: :.ere_Q ~'1"dl.c.)e ~J^'c.-. <~'" Each additional branch circuit $ 6,00 $ CCB license no.: /'2,11"12., I BCD license no.: (,"fS l Miscellaneous fees: service or feeder not included Signing supervisor's license no.: 5 L.J eLf 'S Each pump or irrigation circle (2) $ 63.00 $ Print name of signing supervisor: 'J .Q...roO-.......o...M ~ All \ &."5 Each sign or outline lighting (2) $ 63.00 $ Signature of signing supervisor:~ _12.. ..;-- I-- Signal circuit or a limited-energy panel, $ 63,00 $ U alteration, or extension (2) Each additional inspection: (l~ $58.00 $ AfT,NTION-O ~~~ APPLICANT USE /,/'t1W ..~tI . regon law requires y t (A) Entersubtotal of above fees $I?D~ ". r "& adoot ou 0 t'dillc"tiol; ~ ,ed by the Oregon urn l\Q; (Minimum Permit Fee $58.00) .. o. I,entor Th I I Y 't1" 10M] 952-00 H10'10 those rules are set forth ~~~ '(B) Enter 12% surcharge (.12 x [A]) $ Jlc,v 090 Yo . rough OAR 952 '1 c"l; ~ may obtain copies ofth -001- (C) Technology Fee (5%0f[A]) $ a mg tile center (N e rules by MOnCE $~ I()b<-' umber for th 0" ote: the telephone ".' : TOTAL fees and surcharges (A through C): Ce e legon Utility Notitic . THIS PERMIT SHALL EXPIRE IF THE WORK n nter IS 1..800-332-2344). 440.2584-1 (9108/COM) atlon ,\UTHORIZED UNDER THIS PERMIT IS NOT COMMENCED OR IS ABANDONED FOR Ar~Y 180 DAY PERIOD. .. ;/ .-;-... TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St SpringfjeJd,OR 97477 541-726-3753 www.ci.springfield.or.us 811-SPR2011-01008 705 FLAMINGO AVE permitcenter@ci.springfield.or.us RECEIPT NO: 2011001148 RECORD NO: 811-SPR2011-01008 DATE: 05/19/2011 rDESCRIF!.TiCjN'~'" "."." 0,''':.;7'#' -"~~q_:;::1",,'Pj.-h_ . ."--KC.tQUNT-CODE:!:'-;;- .' ~'.S..'. )' AMOUNT_D.UE'" -," .1 Branch circuits with service or feeder each circuit 224-00000-426102 18.00 Services 200 amps or less 224-00000-426102 162.00 State of Oregon Surcharge (12% of applic!:ble fees) 821-00000-215004 21.60 Technolo~y fee (5% of permit total) 100-00000-425605 9.00 TOTAL DUE: 210.60 LPAYIVIEt:U~1?I:eE,_;_::.)'AXQW,;.i:~..sJ:ll~")~MAc'HA;;O' ';" "'''C_QM:r.rE~tS;,~t..li:;2.P~-'~'-"...-P. AMOUNTPAID-';,', .' " _ h _ ~-I Credit Card food for lane countyfTheodore 210.60 019978 Purdy TOTAL PAID: 210.60