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HomeMy WebLinkAboutPermit Electrical 2011-6-13 j . Electrical Permit Application 225 F;fth Street. Spdngfield, OR 97477. PH(54 1)726-3753 . FAX(541)726-3689 ""DEPARTMENT I.H3'i: ONLY ',i;" ZtO/I ~Ol Y S Date G - /5 - Zo II This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80 days of issuance or if work is suspended for ]80 days. iY, . -! '\'IEOC';L(GOVERNMENT;(,6;rl"'RovAI1l~~;'"~ii!~;f;;'i'";t;i,. Zoning approval verified? 0 Yes 0 No ~; '::c.'; -;"~'1,,CATEGORy:rbF, ;;CONSlRUCT:IOr.n,\",.. .. ". o Residential 0 Government 0 Commercial f!.~V'fi~QJQl3iSI'EE;~INF.ORM)I.'I]ONi:rA..ND~lIb_CJl.TIONJ.'~'f';IiJf" Job site address: City. -,:i~.~}~V,;c:;':.J;~ :;0.;' ZIP: 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: :CONl:RACi;OR INSTALL&;TION: E-mail: CCB license no.: Signing supervisor's license no:: Print name of signing 'supervisor: Signature of signing supervisor: l~ -L..-- 440-2584-J (9/08/COM) ~~i~n~~~~~~t~EEE~SCHEbO~E~j~~~~~~J~~~~~ .' . - -, ..> _ '~.'_.,_"" . ",'. Yl.:';tvf;"';J~f c' . . "'.: _' __ _ .. .. '",":. ,,,.. ;: ~"~'. "":;:: . ~. . ;;''!.,,'~ " >: .. '". ':'-,'- ......":'."..'~. ;." .~';-'. ". Cost, Total ,Number' Of inspecticln"s 'per"iiem~'(). ~',;-", Qty,: "'~' "~ea/~_ . ,. <pst. .'. ':"", . ~"'i. ,,;.,,;- ':.' '':'~., #;",,';' ~(,';i" ",1" . '\;,~:F," ,,\. Residential, per unit, service included: . 1,000 sq. ft. or less (4) $134.00 $ Each addition,al 500 sq. ft or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Services or feeders: installation, alteration, relocation 200 amps or less (2) I $ 81.00 $a.Ct 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 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) $ 63.00 $ 201 to 400. amps (2) $ 87.00 $ 401 to 600 amps (2) $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: 1JfYVrf!!,tf1QQfifl!r, e;-Vr:nsion per panel a. Fee for branchlE",cuits'1:':ith,purlk\seu6;;'hk~l\!iE<,ijf1feelleYM: to , ... . -''''-' a UUIA I ';'" '. Each branch ~i~~!t~a~/;,n Center. tho;J;Jj;:~R6''in $-II/lily b. Fee for branOOcircuifuBIt~MI/; ~fy@ll.'I'1 frs~hl{i~ ~...,. If R\ hf First branch ciRFuW["j the Cente; ~ .".t~i~& u:tes by ...~. , . Each additional b~a~~~,h~gn~ Oref- on U'i!iffv,~-8p,: "):~Ie Q" - Miscellaneous fees: service or feeder ~~tY~6\ti344). Each pump or irrigatiC!n circle (2) $ 63.00 $ Each sign or outline lighting (2) $ 63.00 $ Signa] circuit or a limited.energy panel, $ 63,00 $ alteration, or extension (2) Each additional inspection: (1) $58.00 $ :::;7t~}}(~~W0Jfi,F{1~~;Y'~;ARP.:i1TC'~'" }fr.'. 'SE";"<t""'~":';~Zt,:;"~i-i;'J:r'f,';)'~"':. 1(i; :,...,' . -..\'::~ft;ft;;_ii-'..,~.:'~'::~ ..'t. ~1 '. . . .ANI'!'7U. . ~;,;~,#,~,r,:~.~'h1J>.c~~fN~.f.4E.:n-,,;;:-\~:t,,\..~ (A) Enter subtotal of above fees $ :?/ ~ V (Minimum Permit Fee $58.00) (B) Enter 12% surcharge (.12 x [Al) $ 9- ?~- (C) Technology Fee (5% of [Al) $ '7~ TOTAL fees and surcharges (A through C): $ 9~. 7 7 ./ .; SPi'~~.?ii] ~~ ~OREGON www.cLspringfield.or.us TRANSACTION RECEIPT 811-SPR2011-01413 102 WOODLANE DR CITY OF SPRINGFIELD 225 Fifth 81 Springfield,OR 97477 541-726-3753 permitce nter@ci.springfield.or.us RECEIPT NO: 2011001591 lDES'CRII~.TibN< ~,,". ~> ;;'':;';.<" ",';<0 ,";;.. fr Services 200 amps or less State of Ore90n Surcharge (12% of applicable fees) Technology fee (5% of permit total) RECORD NO: 811-SPR2011-01413 DATE: 06/13/2011 ,.c,,,;,j ,.,;,,!'~T;AC:CO.uNfd::.ODE "!::;''''''; ,,'AMOUNT.DUE' 224-00000-426102 81.00 821-00000-215004 . 9.72 100-00000-425605 4.05 TOTAL DUE: 94.77 :' " ..,'AMOUNTF'AID, ,< '___'_,w,~"""",-,_~, 94.77 L.PA't'M~i:J.T"-txf1J=~:~.PcP:'t'QrL.CASHIE~HA[6~~]A:;j::.ciMME~f.S';,:;,;:'r Cash JESSE RODOLF 01373a /~ TOTAL PAID: 94.77