HomeMy WebLinkAboutPermit Electrical 2011-6-22
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08/19/10 THU 16:15 FAX 5417263689
Electrical Permit Ap
ns Fifth Strod.sprio~n,ld, OR 97477.PH(S41)726.J7SJ.FAX(S41)m~S9
CITY OF SPRINGFIELD
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Tbls permit Is isslled under OAR 918-309-0000, Pennlts are nontransferable. Permits e"pire If work Is not started within ISO
day. of Issuance or 11 work is suspended for 180 days. '
LOCAL GOVeRNMEf\lTAPPRO\1A\';'";~'
Zoning approval verified? DYes D No
- :. ',CATEGOR't<Ol' ~C'ONSTROCTlON,::: . :,' .
0Resldential iT 0 Governmeot I 0 Commercial
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Job site address: ~.., 21 V e-I-- ~o If
City: .:::.~ r~ I State: (\.I} I ZIP: 9 7'77
Rererence: I "lO~3l{ L{ Taxlol.:071,OO
'OESCRlpTION, OFWPRK::,'" "';;: ::'-,'
*d- A / ,4t..:r-GL 4 Cd CtA. .. h-
I
Name:
Address:
PROPERTY, OWNER
SIAltTI-O'U r:?L '111
q .5!!b I ~Ll/i5lL ~, (
.s ,p~'/.. I State: <.\'0.......- lJJ>:-O,-7l(7-:'
. - I Fax: . .
440-2384-) (9/OB/COM)
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l'Iumbe~of!fl;j,~.,j!oti.'pOJ:it~(). ......~. ..1:.. ..... .~fs:I...
Rt.!Iidentlal, per unit, servie:t Included:
1,000 sq, fl. orless (4)
Each odditiOlle.l 500 sq, It or portion
thereof
Limited ..ergy (2)
Each manufuClW'Od home or modular
dwell ing."",icc or fender (2)
$13'.00
City:
Phone:
E-mail:
This Installation is being made on residential or farm property
OWlled by me or a member Qfmy immediate fumily. This
property Is not intended for sale, exchange, lease, or rent. OAR
479,$40(1) end 479.560(1). .
Signature:
. ,CONTRACTOR . INSTALLATION
Business name: ,..';;t)IAJ rQ.\J/'\oIA S e I e[.h; c.
Address: 1.-\ -, <.." wrLS\ 1""1.. 'Ie..-
City: (J!J.f'AfJ"I.' I State: D'iZ WAil/a?
PhoneSilc3/il, ,:z.q-f I fax!;;A\ :?:j.j~ Lil<n~
E-mai!:
CCB license no.: \'\?,LiCl2.- \ I BCD lioenseno.: L l( S\
Signing sunervisor's license no.: S yay (,
Print nllJl1.e ofsiElllulg supervisor: ~"'\,O""'-, ~ 11\"1'''\ c\ S.
Signaiure of signing supervisor' :;+.c...- ___
'--'
ATTENTION: Oregon law require's you to ~~
foHow rules adopled by the Oregon Utility .\
~otlflcation Center. Those rules are set forth ,,)..; (A) .sntcr ""btotal ofobove f..,
In OAR 952 001 <J' (Minimum Pormlt ,..S58.00)
- -0010 through OAR 952-001- \9
0090., You may obtain copies of the rules by ~ (B)Enler 12% surcharge (.12 "[Al)
calling the center. (Note: the telephone , (e) Technology Fee (5% of [A})
number for the Oregon Utility NotificatjoNOTlCE' TOT" , ., .. "h (Ath c)-.
Center is 1-800-332-2344) . ..... .....nv"uro arges rou
, THIS PERMIT SHALL EXPIRE IFTHE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR .
ANY 180 DAY PERIOD.S
. , . . ~
$ 25.00
$ 32.00
$ 63.00
Senh::1,:$ or feeders: install"tion. oltel'atiorl. relocation
200 amp. or less (2)
20 11tl4D0 amp' (2)
40 110 600 amp' (2)
60 I to 1,000 amp. (2)
Over 1,000 nmp. or volts (2)
Reconnect only (2)
S 81.00
$ 95.00
$168,00
$205,00
$469.00
$ 63.00
$,
$
$
$
S
$
S
$
$
$
Temporary services or feeders,: im/olll1tio." alteration. ~/ccalloll
200 amps or I.., (2) $ 63.00 $
201 to 400 llmpS (2) $ 67,00 S
40110 600 amp' (2) $128.00 $
Over 600 amp. or 1,000 volts, see service, r feeders section above
Branch clrcultfll new. til/trafion, ~,ft(!nsjC1t fJlJr pamtl
.. F.. for branch circuits with porchllSC of service or focder ree;
Eoch branoh circuit I $ 6.00 $
b. Fee for branch circuits without purchase f. .ervlce or feeder fee:
first brano~ circuli (2) ; S 55,00 S s:~
, Each additionlll branch oircuit J $ V.OO $ 1/7
Miscellaneous f...: senlleo or fooder nat II eludod
Each pump or iniprlon circle (2) S 63.00' S
Esch slgn...Jlf.ouUine lighting (2) $ 83.00 S
-<'(gnot circuit or alimited~nergy pll1I<!J,
alter.tion, or extension (2)
Each addltiooDliD.pettlan: (I)
:,i~,~~~::::?4~~~ti~~Y::.);{'~~"!,i~AAP41C'~~T:\:U .
$ 63.00
$59.00 $
$
:..)~~.':: I'..i(,:,":l~.:':'; :.':.
$75
$ g7b
$ "3 b:'-
$ 85'17
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~OREGON
www.ci.springfield.or.iJs
TRANSACTION RECEIPT
811-SPR2011-00241
936 RIVER KNOLL WAY
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
. perr'nitcenter@ci.springfield.oLiJS
RECEIPT NO: 2011001734
lDESCRI~TI()W. ',Ii.' -- ".:,'",:
Branch circuits without service or feeder - 1 st circuit
Branch circuits without service or feeder - each additional
State 01 Oregon Surcharge (12% ?I applicable fees)
Technology fee, (5% 01 permit total)
RECORD NO: 811-SPR2011-00241
_ ' -. ',ACCQUN\f':CODE 11,., ,
224-00000-426102
224-00000-426102
821 -00000-215004
100-00000-425605
TOTAL DUE:
DATE: 06/23/2011
p .AMOUN\f.D'UE '
55.00
18,00
8,76
3,65
85,41
: AMOUNT PAID. G",:..c....J
85,41
L~e;YMI;NT"rr",~~,.I_~AYOR ~cASHlER:DBOWLSBY~,,--,C_OMMI;f>lJ_S-,,:'" '-'~';: y,
Credit Card jeramie reynolds
03691d
TOTAL PAID:
85,41