HomeMy WebLinkAboutPermit Electrical 2011-5-19
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. . Electrical Permit Al!.plication
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225 Fiftb Street+Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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DEPARTMENT USE O'NL Y
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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. .
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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.
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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