HomeMy WebLinkAboutPermit Electrical 2011-6-21
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Electrical Permit Application
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225 Fifth Street+Springfield, OR 97477.PH(541)726~3753.FAX(541)726-3689
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Permit no, : $1/-0 / Sf L(
b - 2( ~ /1
Date:
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days ofissuanceor if work is suspended for 180 days.
'. <L.dC~L.,VG()YERNMENT;~APeROVAl..!'_,::~">: 'i_"
Zoning approval verified? 0 Yes 0 No
i' "(f','CAIEGORYtOF:ico",STRUCTION,,:;;;
o Residential 0 Government
,:J.";'JOB,SITE;'INF;ORMATION"AND,'
Job site address: 31{ 9 L d. 1/'
City:.s ",i
ZIP: 9 7l(I(
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:
F;......"~S.:S,......CON:rRACTOR..INSTAtItATION, ......
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Print name of signing supervisor:
Signature of signi.ng supervisor:
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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 $ 63,00 $
dwelling service or feeder (2) Services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 81.00 $,5? I
201 to 400 amps (2) $ 95.00 $
40 I 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 $
20 I 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: new, alteration, extension per panel
3. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6,00 I $ C,
b. Fee for branch circuits without purchase of a sen'ice or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6,00 $
Miscellaneous fees: service or feeder not included
Each pump or inigation 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 inspection: (I) $58,00 $
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(A) Enter subtotal of above fees $8 -::;-
(Minimum Permit Fee $58.00)
(B) Enter 12% snrcharge (.12 x [A]) $ /{),,/</
.(Q1,,\ilI)010gy Fee (5% of [A]) ""V $1.!.l.S
\tb','oil. ..,t<\!ul!gesllAl:tdfoMlb::1' ~ ~T $ lorn
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ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility <.. 0/ \
Notification Center. Those ruies are sel torth l '\~~" "
In OAR 952-001-0010 through OAR 952.001- ~~~
0090. You may obtain copies of the rules by vi
calling the center. (Note: the telephone I)c'
number lor the Oregon Utility Notification of' ~
Center is 1.800-332.2344), ~ T
AUTHORIZED UND~; ABANDONED FOR
440-2584-J(9/08/COM) COMMENCED OR .
ANY 180 DAY PERIOD.
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OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01514
3492 BALDY VIEW IN
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001733 RECORD NO: 811-SPR2011-01514 DATE: 06/23/2011
lDESCRieTION' :k'" '.h"j;;"~~."7..,.. :,,'1: :'ACCOUNT"CQDE;i."'" ',,"AMOUN:UjUE',". :1
Branch circuits with service or feeder each circuit 224-00000-426102 6.00
. ~e..':vi~e:s 200_a~p~0.:.~_______ 224-00000-426102 81.00
____~Iate_o!~e_gon Sur.c~arge (12% o~EEl.i:~~,,-".~L _____-----E1-0000~~_ 10.44
__Techno~~y fee (5% of permit tolal) 100-00000-425605 n_. . ".c_ 4.}5_____
TOTAL DUE: 101.79
Lf'AXM""'I~D'~,,-'-/f-f'~ygB."' CASH!!;_~1DBOWLSBy'r,;";'Cj:lMM"N[S~.'" ii;;;,.'.,. - '--AM()U.~JJ'~~ . . ......J
Check LANTZ ELECTRIC INC 101.79
209
TOTAL PAID:
101,79
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DEADMOND FERRY ROAD
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LEG END
2
CONTROL/FRS
~ Jnstafl model 1040 GPS Gate Opener Card Rack
~ with Relay, model 1000 GPS Phase Selector and
model 1012 GPS Radio Unit w/1050 Cobinet
mounted Antenna ond Coble in model WXCLK-CI800 cabinet.
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CARTNETS
r;G\ Install service oobinet. 120/240 volt. for signal system
V on wOOd pole (Per. ODOT TM455J.
P 0 L F 5
8 Instal! trooted wood strain pole.
W l R F 5
3
G]] Install (N=number) Ne. fG=AWG wire stze) type XHfflI wires.
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Install rX=numDer of cables) control cables wrth (N=number)
AWG No. (~AWG wIre size) conductors.
SIGNAl S
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Install direction W=OirectionJ confirmation light kit
model 575 with Edison Base LED lamp model
TB2-8111-o01.
4
CONDUITS
(~) Instofl {S=sizeJ inch electrical conduit.
o Install wire 05 requtred by power company.
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ST. JOSEPH '-lAY
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