HomeMy WebLinkAboutPermit Electrical 2011-6-22
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. DEPARTMENT USE ONLY.
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g/- 01
Pennit no,:
Date: b -'(2- ( I
225FlfthS~7~~~;;:(~01l5 .
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.
.. .'" .' t~bCAV'GOVERNMENTMPROVAIf~';,M'1PJi;!":~;r.
Zoning approval verified? 0 Yes 0 No
;;~':;'",>i~cATEGORY!;OI7,'CONSl'RUCTION\~' . "
La",
PROPERTY OWNER
Name: (:; (? L.L. "-
Address: ?O r'.t ~ 70 Lf 7 <;
City: EtA.. ~ ZIP: 9'/0/6
Phone:
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'INST AlLATION
Business name: e...1t' P'lV\J- LOMil'\tA.I1ica hd"15
Address: ll( (0 fYI"J;,o", S+-
City: S" /L tV>. State: oR... ZIP: in c I
Phone:)>} _373_ 'J'/'( Fax:2i3-361- fltl
E-mail:
CCB license no.: I ~ ~l{77
BCD license no,:
Signing supervisor's license no,:
Print name of signing supervisor: l
Signature of signing supervisor: au 10
ATTENTION: Oregon the oregon Uti IY
Jollow r~\esca~~~;e~:Jse rules are ~~~:g6\~ .
~o~~~~~~_0~1-001 ~ Ih~~ui~~ ~\~~e r\M-~- QY
0090. You may obtain Nofe., lhe teiePhQ~.e .
calling Ihe cenler. ( Ulility ND\\l19>!\IQ . .
numberior IheO~~~g~_33Z_2M4), ,\
Center IS , ~ ~"
\9~
440-2584-J (9/08/COM)
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<. ',." .;' : ~,;. . ':;, ,. ,,-.' . :';-.' 0" ",..~., .: " ., ~,';- , : ,0> Cost' TolaI'
1,~u""!_b,~r?.!)~JlP.~~~IO,~S ,p~r, ,It~.n,t:,<.} -,;;)_.' Qty. "I,\~ea~~' {" c.ost: ,',:
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Residential, per unit, service jncluded:
t,OOO 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 $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
601 to t ,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 $
20 t to 400 amps (2) $ 87.00 $
40 t to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, a/teral/on, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 I $
b.,Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55,00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder !'lot included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting. (2) $ 63.00 $
Signal circuit or a limited~energy panel, j $ 63.00 $blco
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal 0 'above fees ~~~~
Tf"" n~p,'
(Minimum .l'eTmlt ~liJ$lB3llMLL EXPIRE IF
(B) Enter t:i% 's{;Vch~t'~.n J 'N~j)R THIS PER nIT !IS;j(J(fl'
n""~." ~_
(e) Techn9iQg,\!~~~f~5~$,HM~lSABANDONt DFaR:l'.i5'
TOTAL fees and s"~ii'irge~?Alth'rough C): $ 73.71
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01530
3555 GATEWAY ST. STE 201
permilcenter@ci.springfield.or.us
RECEIPT NO: 2011001713
lbES.CRI~TION S"s p,' ....'..;,,;,..
Data I Telecommunications
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RECORD NO: 811.SPR2011.01530 DATE: 06/22/2011
'>""'ACCOUN:t~c.bDE'''' ',7," ..tAMOUNLDUE," "
224-00000-426102 63.00
821-00000-215004 7.56
100-00000.425605 3.15
TOTAL DUE: 73.71
L '+, :.AMOUNTPAID" .
73.71
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COMMEN"[S.< ~,;,
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State of Oregon Surcharge (12% of applicable fees)
----2.~~?logy fee (5% of permit total)
LpAy[VIENTTYPE (,
Check
1881
r",~~ ";~~YQ8 ; CASHIER:.DBowLSBY
reliant communications 10-09
TOTAL PAID:
73.71