HomeMy WebLinkAboutPermit Electrical 2011-5-23
225 Fifth Street+Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689
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.
:COGAli.5~~OVe~NI'v1EN:r~'APPR()VAI..';';:::::;V~~",:;:; - :,.<07 ,,;. ......,. <"i.:
Zoning approval verified? Dycs DNo ,;, Il;ii~I ;ea,'IT~%~I/
,..:,,+,":;7".cAreG()RY::;()F,;c(jNs7fRU~rl(jN;;;::;';'Th. ;*'.:<
~esidential I 0 Government I 0 Commercial Residential, per unit, service included:
'''f''';~J0~;;;SJ:rE:UjNFORMA:rI()N,AN DIl.IoGATloNr:":*<<f 1,000 sq. ft. or less (4) $134.00 $
Job site address:2/45 3/'71 .5hfcEr SfJ/IC{; iJ:/q Each additional 500 sq. ft. or portion S 25.00 $
thereof
City0P,R/A/6F1E LIJ I State: (J1f. r ZIP Cj7<f77 Limited energy (2) $ 32.00 $
Reference: 170 Z. 30 2- 10 '/2-00 Taxlo!.: Each manufactured home or modular I $ sti 1$
dwelling service or feeder (2) 63.00
#WR.4' /J mtJ~/1/< /. ~m.c Services or feeders: installation, alteration. relocation
, 200 amps or less (2) $ 81.00 s
~.dt:'tJ/J7e lA/liST JJ71/fJ ,..~'''~ 201 to 400 amps (2) S 95.00 $
40 I to 600 amps (2) $158.00 $
Address: ;;?--/LI-5 31'7f-~ 601 to 1,000 amps (2) $205.00 $
City: S ;J1f/ tl/ G,c I e: ({) I State: 01\ I ZIP: q 7tt-77 Over I ,000 amps or volts (2) $469.00 $
Phoneltfl-1?/lr 11314- I Fax: - - Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or fann property 200 amps or less (2) $ 63.00 S
owned by me or a member of my immediate family. This 20 J to 400 amps (2) $ 87.00 $
propel1y is not intended for sale, exchange, lease, or rent. OAR 401 to 600 amps (2)
479.540(1) and 479.560(1). $126.00 S
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
;.,; . "CQI':ITRJ\C7fOR;lINS7fAtL.ATI()I':I'.il~ Branch circuits: new. alteration, extension per pane!
Business name: t, 12. is/? Ab /; 19m 2/vt:-. a. Fee for branch circuits with purchase of a service or feeder fee:
Address: r/; g i4J. 'f)' :5 {--x: eEl Eaeh branch eircuit I $ 6.00 I s
CityS,t?}i(//IIt!,F / cLtJ I State: olZ I ZIP:CJ74-77 b. Fee for branch circuits without purchase of a service or feeder fee:
Phon/$l17~7,M"3! I FaxStJI-7t.f7, 7/57 First branch circuit (2) $ 55.00 S
E-mail: 6/JaL~<1tu'x...71L!f 11.d- Each additional branch circuit $ 6.00 $
CCB license no.: 6'(,'1'/ [) BCD license no.: ZtJ. R7<'- Miscellaneous fees: service or feeder not included
Signing supervisor's license no.: <If'f'l-S Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor:2'4~v ;!3"f/J;h/lH1VA' . Each sign or outline lighting (2) S 63.00 $
Signature of signing supervisor: rL' 2:f: // l- f Signal circuit or a limited-energy panel, S 63.00 $
alteration, or extension (2)
,/ ,/
Each additional inspection: (1) $58.00 $
( ex I SliNG. IJE~~m /1 .i' ).;.
(A) Enter subtotal of above fees
,f/I- 5jJ/U!-O / / - ()~(b3J (Minimum Permit Fee $58.00) $ C3, tf)
(B) Enter 12% surcharge (.12 x [AD $ 7.%
(C) Technology Fcc (5% of [AD $ 3,15
.......... TOTAL fees and surcharges (A through C): $]3,71
440-2584-J (9/08/COM)
~;f;i~
~
~..
SPRIN.GF.I.EL~D .
_..,~..,
. it""
1tio.1
OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Sprlngfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01053
2145 31ST ST. SPACE 19
permitcenter@ci.springfield.or.us
f' 'i~iA~:t' ""~~'T '(11.111"\,1" ,.j '.. ,"rwlwmwIIV""'ln"",nr,in;: ::,I""Tf
~MENTdYPE;I';j,tj,,:HniPAYQ,8:;' cAsHIER:Jl'HQPRERpj;;ji::I'!
Check LR BRABHAM INC
39729
RECEIPT NO: 2011001191 RECORD NO: 811-SPR2011-01053 DATE: OS/23/2011
lQES.CRIP,,:tlo:~' ;;;n'tmmHmm!j~i:ir;: ; ,;i";:!WmmmIlIIUiU;l;ilii in"?'irnmlM1fJUllImm!la!iaJii;,:::):j!:11i;ft~C~ej;)UNjtic~o~EfE~~1!l!llm!lI~Dillilllii~;;ll;b:;"i:}~V~}i!.iMOJlNff~e.UF;~it~~!::
Fi~?<j)~!111
Ea manufactured or modular dwelling, service, feeder 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
ti~~.1I1!coMMENTs:~ili'~~~t~rnl!11!1I1111I1UllrnmlllllllliiIl11111I,tAMbONl1!e~I[)_Ii!:ii.i,li,l
73.71
TOTAL PAID:
73.71