HomeMy WebLinkAboutPermit Electrical 2011-5-19
Elr-ctficaI Permit Application .
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22S Fifth Street. Springfield, OR 9747HPH(S41)726-37S3+FAX(S41)726-3689
DEPARTMENT USE ONLY
?eUi;n; r
Date:
5~lq- II
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.
.. "LOCALl;>OVERNMENTA~PROVAL,:.t,,;:<:,,:.
Zoning approval verified? DYes DNa
/;", "':,;CATEGORy((jI'CONSTRUCtION~ ,..
o Residential I 0 Government I 0 Commercial
~$ffi:ji~~(jB;isltl:::;'INFQRMATIQNFAN[j!i:I!.QC;Ati()N'.~ii;i};';,i
Job site address: '17;l 5c.oHs l-rIen
City: Sf.lrl"'IIC,H State: (')R I ZIP: Q7'f77
Reference:' \ 'lU-j;.r I\"~ I TaxlotNqcc::
DESCRIPTION OF WORK": :;.':;..':
r?",nr.;rJRM/cu," u-Z- h~,,,,f wire-'"
, .f)A~ J, I( -\?if'"
PROPERTY OWNER
Name: n;IW1P j::' ;-/-"';e~
Address: '17::A <".Il" Irl"",
City: <v.,I~" eelJ I State: 1'Jf2 I ZIP: Q707
Phone:SV! -JB5= (YJ/6 I Fax:
E-maiI:
This installation is being made on residential or farm property
owned by me or a member of my immediate family, This
property is not intended for sale, exchange, lease, or rent OAR
479.540(1) and 479.560(1),
Signature:
CONTRACTOR INSTAllATION
Business name: '2, (JJ ,-/ f.
Address: Prl i':SM </g:7
City: fIa"f.,IM", State: 01<.. I ZIP: q 7'1'16
PhoneS'/! -)Iri()~ I Fax: - -
E-mai): l" :2Lt1., I,x:lr, <-e!-o,ol. ca"",
CCB license no.: /OJ! 3'1' I BCD license no.: Cc, lfq
Signing supervisor's license no.: 5t'~ ("
Print name of signing supervisor: ...s"~^,,, <vw>f~f~
Signature of signing supervisor: ~ , ""-
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440-2584-) (9108ICOM)
i-~>':-;.':<';\;,~:~5,;s"~if~~~~.~o/.$~~:~~:?:f~'-FE.~~,SCH-E._P_U-L3E::(Jl;Z~Yd5rjl@~~'(~~S't~(;~~'>iSI~~y)
".-, .-.,'
Numb~r opnsi>eciioti~wite~ O. Qty.
Residential, per unit, service included:
Sost 'Total
('. ea~. cas!.
$134,00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
1.000 sq, ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
Services or feeders: installation, alteration, reLocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 96.00 $
401 to 600 amps (2) $158.00 $
60 \ 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)
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)
Each additional branch circuit
\ '. $ 55.00
;:).. $ 6.00
$55
$ 1'J.
Miscellaneous fees: service or feeder l}ot included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
$ 63.00 $
$ 63.00 $
'.:0' i-rcuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each _adition_1 inspection: (1) $58.00 $
:K{ijX:~Wt4!1.~t~t~~'i1~1~1~ARe_~TcANT;~FtJ s,Et~~;~r(~.7: .::i?::,:B:.;~~\\,;:;;;r;':' .;.:_:,
(A) Enter subtotal of above fees
(Minimum Permit Fee $S8.00)
(B) Enter 12% surcharge (.12 x [AD
(e) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
$ 67 CI-
$ 'f..Of
$ S. ~(
$/S,n
.>r
.
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.US
811-SPR2011-01007
472 SCOTTS GLEN DR
permitcenler@ci.springfleld.or.us
RECEIPT NO: 2011001147 RECORD NO: 811-SPR2011-01007 DATE: 05/19/2011
t1:lES.CRIe:tibN?,.~~?4' <':'~i'~>;:';''''14:F,X "'i~':::'\ : '.'~ACCO(j'NT~CODC~ t,,'~;" 'AMOUN'LDIJE" '. : j
Branch circuits without service or feeder - 1st circuit 224-0000Qw426102 55.00
Branch circuits without service or feeder - each additional 224-00000-426102 12.00
''''''-'-,~ ----.-
..2".!e of Oregon Surcharge (12% of applicable fe~sL_____... E]:9E900'3.15004 ..._..___ __.. 8.04. ..__
Technolo.g.Lf.".~J5% of perm!!,!o!al) 1o.9.:9.0000.4256~.....___.__.__ _ __ _ _ 3.35__.
TOTAL DUE: 78.39
,', .COMMENTS~>'tr 'r';.'" ;-'~;:":,::~..,,AMOUNT f'AlDi;,'>"' ""?o""'';']
"'..........._..".__,..,_.~_. __ _--....-,.~...... __ _ H. . ..k_".,~
78.39
bFurCIVIEI'lL1Y:P'g' ;,;L:-ell-Y.Q~; :-c](s'HIER!)I.,ACHADO'''';" ::;.
'Credit Card . JASPN SMATHERS360 ELECTRIC
0000007
TOTAL PAID:
78.39