HomeMy WebLinkAboutPermit Electrical 2011-4-20
Ele..ctrlal Permit Application
'CITY' OF_SpRiNGFIELD: OREGON .
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225 Fifth Street. Springfield, OR 97477+ PH(541)726-3'753+ FAX(541)726-3689
DEPARTMENT USE ONLY
t"1:-5F6220l [ - Ocx"L{ (
PermIt no.. .
Date: Lf .- 2..0 ~ ( (
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. .
. LOCAL: GOVERNMENT APPROVAL
Zoning approval verified? DYes DNa
,CATEGORYOF.CONSTRUCflON)'
Residential
~?'~ilOB';'SIT .
Job site addre~s;
PROP!:RTY OWNER
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:
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ATTENTION: Oregon law requires you to ~
follow rules adopted by the Oregon Utility .
Notification Center, Those rules are set forth
in OAR 952-001-0010 ttirough OAR 952-001-
0090. You may obtain copies of the rules'by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
440-2584-J (9/08/COM)
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
,.....,\(;:,~,'i}<)'~iii1):./:FEE':SCHEDUljEr ~::~:~;'ifi~>if~:8{~tr~~~~l:f~~~
,Numl?er' of.inspectjo'n~ p~r'it~in'(.) .~: . Cost Total
.,'... . ..,' .' "".' Qty. ;,"e;i. cost
Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft, or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ $
dwelling service or feeder (2). 63.00
Services or feeders: installation, alteration, relocation
200 amps or less (2) 1 $ 81.00 ~T:Y
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 tn 1,000 amps (2) $205.00 $
Over t ,000 amps or volls (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!~p'~,or 1,000 volts,.see,services!or 'fi::e(fer\I\~~Hiorn above
. d_ ",'11\. I '"" ""-1, B... \. - _ .......'T
Bra~'ti ciriU'{t~~\WJ~, v' 1/ ,......- ,~ 7'l....nl\n11 \~ \\I,V 1
.__,-r-t. fl!fw:qf1'1f1,~,eN~!JSl.onper pa~EJ!....
a. Fee,for branch'cjrcuifs~ with:purchase 'Ota\'servlcPd~ feeder fee:
. .,.^r"lr'l-Il l h 1--... ,....... ..-'
.r-IIV'.....'. --- PERIOD.
Each R~~~h ,e,irp!l.it( $ 6.00 $
b. Fee for 'branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $ .,.1
Each additional branch circuit '}) $ 6.00 $17'.7'-
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspeetion: (I) $58.00 $
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(A) Enter subtotal of above fees \$Ir
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ 'E; 1rl'L
(C) Technology Fee (5% of [AD $~ ~Oc
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541.726.3753
www.ci.springfield.or.us
811-SPR2011-00641
7606 MCKENZIE HWY
permitcenter@ci.springfield.or.us
RECORD NO: 811-SPR2011-00641 DATE: 04/20/2011
. ,,.-..-.t_'\Y'~':J:'.~:1t'._ !+:Ac;c;OUNfic;"dDE; '/.f. '-:d'i.AMOUNt~[)UE-.' '. "!
224-00000-426102 81.00
821-00000-215004 9.72
---.----...
100-00000-425605 4.05
TOTAL DUE: 94.77
" 'PAVMENj:'P(..pE-'.f ii"'c~PAYbR~i':CASHIER:NMACHAD6 .~1;t;.;~:;,:'~ c6MMgNT5:;.i~;~)C:,;"~ . '''1' ";:~ ._~...MOUfI!71; PAIQ. " ..'
Credit Card Everyday Electric / Tony Antone 94.77
014560
RECEIPT NO: 2011000756
lOESCRIe.TION'''' ,4.,' ;":'~"! .
__~,erv~es 200 amps or less
__~tate :!.f Ore9_C?n Surc~arge J 12% of applicable fees)_
Technology fee (5% of permit total)
...::.J
TOTAL PAID:
94.77
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
W\NIN .ci .spri ngfield. or. us
811-SPR2011-00641
7606 MCKENZIE HWY
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001387 RECORD NO: 811.SPR2011-00641
lDESJi,RIBl1IQNII'I'III'lallilllll'IIi'III'II'IIIIIII!!iII'lall'!llI1I111111111111111111111111111a1111!1I1.lIl!11l!ll1ll!ll!ul!1ll!l!lill_~~:C_QUNiT;:i::::ODE" ," " .
Branch circuits with service or feeder each circuit 224-00000-426102
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology fee (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: 06/01/2011
Ii". ,,'Ii",I"~Me.I:JN;fre:lrEl!ll!1lIl1ilUI!" ',"I" 'I
18.00
2.16
0.90
21.06
I . n'~.~, -'-'. ._"d_,..~.," .~""~ '_'i~'Vljlil'n"'''"';~)'Y'-',\,-'''T.!;n'n1J11i1iWltMm!%:1Jlm%;WiiWJj_I~~I1~~r:1'ml'''_m;;oA\'''''''''''-'''''''''llmtl:''''r!t1''nfi~'fN'il$''1ml'lU?lm'ft1W!C?'!r
yl1'FAnM'~'O"-""U-'-"N- :T:PAID"~~l'!I'!I'!dj{"w"h'''''i11
~MENTi:BiPI;:.';::;I,:l:;~I;j!'PA'tOR,/I:';CASHIER:NMACHADOh!d"d~~U::,,';,\jCOMMENTSl,jx'mrJt'\ :lddl;mjlll:tJJL)",~'j1 :nt"" ,,~,;, ....,' :"1" .. A . ' . , 1!H,,~,,~,;:.':Tl'"
Check
469
SATHER RONALD G &
MARCELLA R
21.06
TOTAL PAID:
21.06