HomeMy WebLinkAboutPermit Electrical 2011-4-5
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DE~ARTM~~T USE ONLY.
~.sP220II- to
tno.:
Dale 4-5- '20 ,(
This permit is issued under OAR 918-309-0000. Pcnnits a~ nontransferable. Permib expire if work is not started within 180
daysofissuancc or if work is suspended for ]80 da)'s.
~'LOCALGOVERNMENTAf>f'ROVAL:. >, '. . .
Zoning approval verified? 0 Yes 0 No
, ' , 'CATEGORY. OF. CONSTRUCTION ,':' "
o Residential I 0 Govenunent I 0 Commercial
,', JOB SITE INFORMATIO~',ANDLOCATlON '
Job sile .ddress~~ y=::;- ,:::5'" ~
City: I State: I ZIP:
Subdivision: \ ~ lJ.)~D'.,~ \ I Lot no.:( )'-'\."'1.1 )
.. , . DESCRlpTlON.OF WORK' 'c" ..
~ (')'01-0-1 -.QJLI s'fU\.)(" . ex CU I is
)..i-Ff 1 FlUA:' Li" A,
. ., .:. ' ". PROPERTY OWNER : ',' 'j
( r' ~ (-
Name: ". r'K S U0~~ \ 'ZA- D
Address;:-,l lS' S -t-" -.J
Ci~:;l IJ IStatecf-J I zIP:ChLf77
Phone-Y~ ,) 7 2.A.tv 57 'ax - -
E-mail:
This installation is being made on residential or farol.property
o,...nOO by me or a member of my immediate tamily. This
property is nol intended for sale, exchange, lease, or rent OAR
419.540(1) aod 419.560(1).
Signature:
, . CONTRACTOR INSTALLATION, :';-
Business name: \ k' r.. l- I (J r+v t i. .) -,I.Jr\ r
Address: Z.1"5"~(\ --;- .r
CilV <;: ^ rr 0 (( I Stale 0 V I ZIP Ci14-11
Phone: ~l :14"-,(...,,. ! Fax:'Stl-I -14h-3~55
E-mail: --;:;>~(@~t<"..e:IMA:_.o1V\
ceo licen':' no.: 4'5 12..'1 I BCD license no.: 20-2...,C-
Signing supervisor's license no,: 4'il'''''S !
Print name of signing supcrvisor:"jnJtu.D I I L.v V ^ n l""..~),,,,,
\~ ...,
SigmlhlTC of signing supervisor:
u
I w requires you to
ATTENTION: Oregon a th" Oregon Utility
follow rules adopted bJse r~les are set forth
NotificatIOn center.16~hrOugh OAR 952-001-
in OAR 952-001-0gtain copies of the rules by
0090,. You may 0 Note: the telephone
callmg the center. ( n U'ility Notification
number for the. o~e8g00 0_3~~-2344),
Center IS ,- ~ 'IJ Ci
-""".~"~ it
"., '. ,'.,':'. FEE SCHEDULE', .C,
.Nti'm~r'or~~~o~s~rite~,6' ,_" 'Qt)..\-.. .C~t ., ~:~~I
I<<sid.ntial, IW'f unit, sprvice included:
\,000 sq. fl. ",1= (4) $134,00 $
Each additional 500 sq. ft_ or porticm $ 25,00 S
thereof
Urnited energy (2) $ 32,00 $
Each manufacwred home Of modular $ 63.00 S
dwelling service or feeder (2)
Services or fec.-ders: instal/alio". alteration. relocation
200 amps or less (2) $ 81,00 $
20 I to 400 amps (2) $ 95,00 $
401 10600 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 fe.eden: installation altemtiml, relocatiml
200 amps Of 'ess (2)
20t to 400 amps (2)
40110600 amps (2)
$ 83.00 $
$ 81,00 S
$126.00 $
Over 600 amps or 1.000 \'olts, see services or feeders section above
Branch circuits: new, alteration, exlension per panel
<1, Fee for branch ci~uits with purcha.<re ofa service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits ,vithout purchase of a service or feeder fee:
First branch circuil (2)
Each additional branch circuit
I
II)
~
'C .
$ '1~. r;CJ
$ 55.00
$ 6,00
Miscellaneous fH'S: service or feeder not included
Each pump or irrigation circle (2) S 63.00 $
Each sign or outline lighting (2) S 63.00 S
Signal cln.:uit or a limited.cnergy panel,
alteration. or extension (2)
Each additional inspKtion: (I)
$ 63.00 $
$58,00 $
, ,,'.
':<.:.J' AePLlCANTUSE
$ /21 o-J
$ I <S:- 2-1
----
$ 6. 3'>
$ , /, sq
(A) Enter subtotal of above fees
(Minimum Pumit Fee $58.(0)
(B) Entl..-"1" 12~ia surch:uge (.12 x [A])
(C) Technology Fee (5% of {AD
TOTAL fees and surcharges (A through C);
, . l\-1t \NORK
~lOliCE, MIl S\-I/l.LL t~PIRt ~~M\1 IS NOl
T~~~~:~~LtO UNO~! ~:~~60N~O FOR
',Q\\~N\tNCtS ~~R\OO, :
\'1'1 '\80 or" ·
..
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SP~~N~~
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~OI(EGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-5PR2011-00545
225 5TH 5T
CITY OF SPRINGFIELD
225 Fifth SI
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
. 'L AM~OUNJ~DUE ,. "CW', ">'1
6.00
55,00
66.00
15.24
6.35
- ~~_..._..- ---------
TOTAL DUE: 148,59
1:"':PAYMENf--ryI'E~',,"';;'PAYOR '~cAsHiER:NMAcVADor >;;~,,::'J>'.'a;Or.rNII:NTS:';"T,,;'\f'if;;i<.. '(,,' "AMOUNT PAID' "",v~ ( . ''''/J'
w... ....,..~.~.......~...,__."'.~.--,_.....~"'-'_~__._~~~____~___....."_,_"'_."-"..,._~.__._~,= _ _.' ..._ . . .__.,,_ _....._
Credit Card' JK GUCKENBERGER ELECTRIC 148,59
055310 INC
RECEIPT NO: 2011000656 RECORD NO: 811.SPR2011.00545
U:j'E::S'(;Rn:rI'ION:"0'0T:;',~ ~~,'" ";:;;';::.t;?"",;T;r,:r;"^",,.~~'*it..;g~k:(;:CO[iN'J~C5DE" ''''S /,~ -
Branch circuits with service or feeder each circuit 224.00000A26102
--~. ..
Branch circuits without service or feeder - 1st circuit 224-00000-426102
Branch circuits without service or feeder - each additional 224-00000-426102
_ _~e_~f Oregon Surcharge (12% of applicable fe~sL-._ 821.0000..2:?15004
'0 __ !.e.c.hn~l.ogy'!"e (5"1o~eer~it total)____~__,_,__~__,____229~00000-42560~___.___
DATE: 04/05/2011
TOTAL PAID:
148,59
FROM ~KG Elec~ric Inc.
(TUE)APR
5 20" '2:24/ST. '2:23/~o.7600000650 P
lectrital hrmit Application
~:~1~~~~111t~k, " '.'~)' '
DEPARTMENT USE ONLY
5 fIfth Strn". Sprintfhld. OR '1-477. PH(5041)716-1753. F.\..'\:.(s.l1 )716,,]689
..,', ,!
:~~~1i~~;;~~_0~~~~ Permil no.:
Date:
,_ ''i>~ ~ '1 b
'hi~ ,permit iJ iutM:d under OAR 9J8-309--OOOO. Pennib Iln! nontranrferable- Permit. es.pirc ifwoti( 'iI not started l"ifhin 180
8Y~ of iuuanec or if work is s..spetld~ for 188 day...
Cil)':
IJhone:
F:'mai\:
This installation is being mndt: on re::;idential ur farm property
l" '\ by Ole or a member of my immediale family, Thi;:;
p.,_.-_.'ty is not intended for sale, exchange, lea.<oe, or renL OAR
4 79,540( I) and 479,560(1),
ZIP:
---
FEE SCHEDULE
Number of ins~ctioos per ilem ( ) QI}', COlt Total
""- cost
Reeidrnti.aJ, prr unit, service included:
-
LOOO sq. fl. orles.... (4) $134,00 $
,--
t:.ach additional 500 sq. fl. or portion $ 25.00 $
lhcroof
Limited energy (2) $ 32.00 $
EAch manu!aclllrcd home or modular $ 63.00 $
dwdlinE; servicem rcedcl" (2)
Sc-n.icn or r~us: installation. altt!,-affcln. ,-e/oc(Jfioll
-
200 amp1i or 1~!' (2) S 81.00 $
201 to 400 amps (2) S ~5.oo $
f--- $158.00
4<11 10 600 .mps (2) $
.---
60 110 IJlOO .mps (2) , $205.00 S
Ovel" I,OOO.:unps or volts (2) $489.00 $
Rccoona..1. only (2) $ 83.00 S
I Temporary senica or fr,eden: installatiun, altera/iulI. rdocatia"
200 amps 01' \ebo'1> (2) S 53.DO S
20 I 10 MlO amps (2) S 97.00 S
4Q I (('1600 cunps (2) $126,00 $
Over 600 an\ps 01" 1,000 ~o1ls, see services Of feeders section above
BrllJu:h circuits.: IWW. alteration. ulmsion pupanel
a. foe fOI" bruncb circu1ts.: with f!Ul"c-hasc ora foCrvice or reooer fee;
\ -,
Each bnmch ol.;if(.U~\ $ 8.00 $
b. Fee for branch circuits withouf purchase of a servicc or feeder fee:
first branch cin:::uil (2) I S 55.00 S S1-
E.l:lch addilional bnmch ~i~ujt 17-- $ 6,00 $ -n..
Misct'llaneous fees: service- or feeder nol included
each pump iN img.:llion circle (2) S 83.00 $
r- Each sign or outline lightinB (2) S 83.00 $
SignaJ circUit (If a limitcd-Qn~rB~~ panel.
allenrtion, or ex'1a1sion (2) $ 63.00 S
Ea<:b .ddilioaal inspKlion: (I) 558.00 $
1-. ' APPUCANT USE
(A) Enter subtotal of llbove fec!ii $ 121- -
(F\.1inimulR Permtr F~ S58.00)
(B) Enter 12% surcbarge (.12:< [AD $
-
(C) "echn()lt."'8>~ I:c.c. (SG{~ (\f\A\) $
TOTAL fees and surchaf1\" (A 'hn.ugh C): $fL-l ~ .-
T
LOCAL GOVERNMENT APPROVAL
',oiling u~lpfo\'al verified? 0 Yes 0 No
CATEGORY OF CONSTRUCl10N
] Residential lO,,-crnrnent 0 Commt'fcial
JOB SITE INFORMATION AND LOCAl10N
+
ZIP:
.(It-, site address: Z. '2-7:,
:i'y StFt-d
)ubdlvision:
LotntJ.:
<:;>J l!)L.....-fI OA)
Name:
Addres,,:;,:
Signa lure:
CONTRACTOR INSTALLATION
Hu.."iness name:
City:
Phone:
E-m:lil:
Si~ing supt..'Tvisor's license no.:
Pri.~_~,name or sig.ning supervisor:,
!-iign.1lllfc of signing. supervisor:
--l.n~5l:l4-J (0-'OlilCOI\l)