HomeMy WebLinkAboutPermit Electrical 2011-4-8
225 Fifth Street. Springfield, OR 97477 .PH(541)726-3753+FAX(541)726-3689
Dale:
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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. .
, .,' , [OCAVGOVERNMENTAPJiROIJAl\:'i'\/, 'j
Zoning approval verified? '"'l:ZI Yes 0 No
.:;" ..... .......:C,6,TEGORV(OFCONSTRUCtION./ .",
.'Ca\Residential D Government I D Commercial
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Job site address: Rt..J '< :<\ H"l ~ I.d
City: L /~, State:~ ZIP: (\- Y--I~
Reference: J \' V OOi}.fY. , Q J I Taxlot.: r A
.' 'DESCRIPTION OF WORK"'" .,',:;:'".,
. "So^^f /'11 J~- /).... \Ii::>
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PROPERTY OWNE R
Name: . lVl .' (ZiJ 14 R '"' ~ +, I
Address: s<"L.~('" r") 42
City: t1'a-eI,) State: ~ ZIP: q,i-rr
Phone: .51'-/'?~ ':2,2> I Fax: - -
E-mail:
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 INSTALL-ATION
Business name: C f) ^ .""'-? r.;-or ,.;;.
Address: Po.{oi< ( . i,l +n-r:: h 119..
City: State: zJ~:rll{;?l7i--
I Fax: - - 0 Go -).,-<:
Phone:
E-mail:
CCB license no.: "'11n ~/\ '-/
BCD license no.: 2b . 30> ~
Zf"'jq -c:.,
?, 37A 'fJ No
rif)
-
Signing supervisor's license no.:
Print name of signing supervisor:1 ^- I 1
Signature of signing supervisor: 1 .~:" T" ;lJ"
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~'f~~~;EE~MiT SHALL EXPIRE IF THE WORK ,~~\
\UTHORIZED UNDER THIS PERMIT IS NOTW ~:\"~
fJ[/]I.li[NCED OR IS ABANDONED FOR . v:..
, < q'J CI\Y PE!iIOD. . ~ .
440-2584-J (9108/COM)
;,~"~;;;\'Rtf>;:l;1rl~~~;'~0~~~r,~~::;ri,~EE.~fS'G_H.EOJJ[E:f~\\lt;h'l:~#F:;,tWf~if~~$:~~~~~i~
,',' ,-, " Cost"
,Numher orinspections perjtem'(,) ..' <ity.
, . ,:.,. .", .. ~~ :.- "c _" '\':' , .':.. i' ea:
Residential, per unit, service included:
Total
cost.
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)
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
, ,
$15/
$
$
$
$
$
200 amps or less (2)
20 I to 400 amps (2)
40 I to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
1 $ 81.00
$ 95.00
$158.00
$205.00
$469.00
$ 63.00
Temporary services or feeders: installation, alteration, reLocation
200 amps or less (2) \_ " es y.,l"L$Ir..
~",,""~'''lT:n''do r llop,nrm h\rv requl ,u3.00 $
2\(i:;'i?\~69@mp-s(2)~Jpted by the .orE gon :'$~~7.,00 $
40:h'toj606iarnp~('i)ter. I flu::;.t: I u,lr;;v u.... ~~ '2' $' -,: J, $
._ _ _ _ "" .. ""-I n H...."llnh OJ IR 9... - .120:00
O'\}e~,)60'O,~Psl~~j ,0'0'0 :~oltsllsee: servoices16r lfeeoer-Psection above
('lIlt f I Yilt. I lav U....~....." . -1-" .,
- - - "0. '" ,_ ,......,t"{ It-I,rlte' T118 !.t::lt:I-JIIV~~::,
Bra~c~lCIScults: mew,!! tera!}.9n( 1~~~~~,sfH~Rf/;'P'qr~h
a frieffor Branch lc{rcuii! 'Wfili.ourcha.::{e:of,?)service or feeder fee:
("'.....,..,tor Ie::. -I -hUV~v-v'--'--V' .
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase of a service or feec:ler'fee:
First branch circuit (2)
Each additio'nal branch circuit ..
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each aoditional inspection: (1)
$ 63.00 $
$ 63.00 $
$ 63.00 $
$58.00 $
".. >,'.:,
$ 81.60
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% nf[AD
TOTAL fees and surcharges (A through C):
$ q, -r -
$ Lf.or
$ qLj 77
....
I
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00570
845 S 42ND ST
permitcenler@ci.springfield,or.us
RECEIPT NO: 2011000683 RECORD NO: 811.SPR2011.00570 DATE: 04/08/2011
'D'E SCR. "f'I ION''- .',,~-,-."'. 'A.. Cl'<~ ",,'''.'' -""~"'" ....... ":',".', ,.. ''''''''''A C"C'O', U"N'T"'CO" DE'~"" .?'''H&'''A' 'M' 'OUNI'D'UE " .7, " '1
L . _:. ~X"":~~""'~"23""">a=L';'''~,*"L ."..".~~~,...,..-,,-.,....,'t:.:..'_ 1::' .~'.o"'P{!,~~'" '\.J__ " . ,-" _'-~_:;;'_
Services 200 amps or less 224.00000-426102 81.01!...__
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 9.72
Technology fee (5% of permit total) 100-00000-425605 ~05
TOTAL DUE: 94.77
" 'P"A'YME'N'" T""""E" i'.:..nA' 'YO'R' "'C'A's"H'I"e'R'N'M' A' 'C'H""'A' '0"'0';; ; ",':;>,: -'C"O~'M"M-'E"N"-T"S-;;::;;~""-~".; ':-..1.0'7 :.*c'Y(.A. . M. OOIllTf'A. 10.'... '_-'-
krP, ',' -I'-~IOI,r::: '~,"/ "",r::: ". . ,~'.., ,'. 1 ,..... .'.,.__,. __.__"._~.';""~..;'. .c'. ",-,. J. ~r. .-'!. "'^"' --'1:,,",",,0;;,;..;.;.' .,"" _' " .
Check WALTER J CANNON 94.77
24028
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TOTAL PAID:
94.77
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