HomeMy WebLinkAboutPermit Electrical 2011-5-23
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Electrical Permit Application,
225 Fifth Stree,.Springfield, OR 97477.PH(541)726-3753t FAX(541)726-3689
DEPARTMENT USE ONLY
$fIlWI/rO /0 Lf L1
Penml no,:
Dale:
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.
.,' :lOC~L;. GOVERNMENT A~PR.OVAl!',,}:":":/';':" ;,~"~::::';i\i;,:i;,?i:~~,f;lN'M\;jj~;.:~f'~ f,EE;i':SCH E_P,WUES:,~;;?t{~'i,_fti~:?tr~~1i#'ii~~~Z:::;r~~~~~~
Zoning approval verified? DYes ONo .. ",-,'.' .' Cost Total
!Nu~~er' oqnspectio'~s pe! i,t~.~.' (.) _ Qty. , ea.", c.ost
" '.C..;TEGORY\'OFCONSTRUCTION'),' ., . .,., ., -,_.... - -, ,,"-
,.... Residential, per unit, service included:
tQ).esidential I D Government I D Commercial
1,000 sq. ft. or less (4) $134.00 $
~"~i"jol:l"'$ITE';INFOR.MATION;';AND>;[()l::'AnON"<"'-'"'' "
\::; j1~.-I," . ,;,1;, __' ',- ,_ n_:'. ___.,~', __.'" '_.~, _ ._, _'__'~~~!'\~,~.'-~: Each additional 500 sq. ft. or portion
Job site address: ,1 .P j: '::>T, thereof $ 25,00 $
City:Sf'lZ.lIUO Fl4~ State: t) fL. ZIP: T7Y77 Limited energy (2) $ 32.00 $
Reference: 170.33,S-1 Z- , I Taxlot.://} 00 Each manufactured home or modular $ 63.00 $
DESCRIPTION OF WORK; ',':."';'-.!\:.:';.' dwelling service or feeder (2)
CL<A-v v-p UJ lQ..I t.<J~ { .v (;. OiJ'.>C- Services or feeders: installarion, alteration, relocation
A-bt:,. AJ.aJ C,lcZcu/T3> 200 amps or less (2) $ 81.00 $
PROPERTY OWNER 20 I to 400 amps (2) $ 96.00 $
Name: bow lA..h/r(-e-L- 40 I to 600 amps (2) $158.00 $
Address: 60 I to 1,000 amps (2) $206.00 $
City: State: ZIP: Over 1,000 amps or volts (2) $469.00 $
Phone: - - I Fax: - Reconnect only (2) $ 63.00 $
-
E-mail: . Temporary services 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 20 I to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR 40 I to 600 amps (2)
479.540(1) and 479.560(1), $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: 4-( E LGCTR.-IC a. Fee for branch circuits with purchase of a service or feeder fee:
Address: p, 0, \5ri))( LJ(~f3,( Each branch circuit $ 6.00 $
City: 6~ "G-tv <e.... State: CJe... ZIP:t{7ifo4 b. Fee for branch circuits without purchase of a service or feeder fee:
Phon6'f( tuBiL:r 2-'(9, 7 I Fax: .. - First branch circuit (2) I $ 55.00 $ 5)"
E-mail: C. A!>?;5 PvP &.. C.O"'1('t4~?, J./~ Each additional branch circuit 'f $ 6.00 $ Zl(
CCB license no.: 1 '-1.'1'<(37 I BCD license no.: ZO-'t7"""&G. Miscellaneous fees: service or feeder '}ot included
Signing supervisor's license no.: 41?8fp5 Each pump or irrigation circle (2) $ 63.00 '$
Print name 0 . ipg"'llII~tvi,n" "": <-> </".' I 6fi4.~td Each sign or outline lighting (2) $ 63.00 $
Signature ofOll~~!O~~.B 6r~itt.-t - 3jgnal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
NotifiCation venter. I :~J1~" <Oil _Q1i1J Each additional inspection: (I) $68.00 $
In OAR 952-001-0010 through OAR 952- 1-
0090, You may obtain copies of the rules by ;:~~i;i~{~~~~~~N~:~~J,~\ARelifc:ANT~:~tJS E:~;1.,;:~.~';'.~.!~}jl:;:~;~~;~.:',:~;;'Y~':';.~'~;
calling the center. (Note: the telephone (A) Enter subtotal of above fees
number for the Oregon Utility Noltfrcatlon (Minimum Permit Fee $58.00) $ I.
Center is 1-aOO-332-2344). 7
~~.\\ OJ ' (B) Enter 12% surcharge (,12 x [A]) $ 'jlfoS'
NOTll(G}TechnOIOgy Fee (6% of(A]) -:"""'?" ". $ :39('
.' \9 l~'S :,~ ,l'IPo\\'a'iJ,fi TlilhM\lgRIC): $ 9 "1 '[l.
THu "L UIWCN I nl<l ~,,,,,II I::> NU I
440.2584.) (9/08/COM)
~~
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
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SPRINGFIE~
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TRANSACTION RECEIPT
CITV OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01044
716 F ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001306 RECORD NO: 811-SPR2011-01 044
iDESCRlI'JION .; .......:L-~..C:-!,_._____ACCOUNT_CODE
Branch circuits with service or feeder each circuit 224.00000-426102
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Branch circuits without service or feeder - 1st circuit 224-00000-426102
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State of Oregon Surcharge (12% of applicable fees) . 821-00000-215004
Technology fee (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: OS/25/2011
.. AMOUNJ.D.UE_~
24.00
55.00
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9A8
3.95
92.43
AMOUNT PAID
92.43
LeA,(I'!Ij:t:l_LD'J~E':':':"""eAYjlR 'hSHIER,'NMACHAOO _"'_
Credit Card DONALD WALER
01125b
CQ!'/I!'/IENTS . ....
TOTAL PAID:
92.43