HomeMy WebLinkAboutPermit Electrical 2011-6-30
. Electrical Permit A
.
Permit no.:
51 -/(,.7'7
. :J 0 II/'
225 Fifth Streel+Springfield, OR 97477. PH(541)726-3753t FAX(54t)726-3689
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DEPARTMENT USE ONLY
Date: &
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 FEE SCHEDULE
Zoning approval verified? DYes DNo Number of inspections per item () Qty. Cost Total
ea. cost
CATEGORY OF CONSTRUCTION Residential, per unit, service included:
D Residential I D Government 111commercial 1,000 sq. ft. or less (4) $134.00
JOB SITE INFORMATION AND LOCATION $
Job site address: q()\) ~t,LV"nn.l.-11'I1'\a P Ii iLIA Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City "';')0.9\ d <. I State: D (2 I ZIP: q, q--V Limited energy (2) $ 32.00 $
Reference: No';:? 6'70 I Taxlot.:Qo 5?JO Each manufactured home or modular $ 63.00 $
" DESCRIPTION OF WORK dwelling service or feeder (2)
1 YL ,,;-,;to. L\ (7z, '\ heN\'\. hh Db> .. , Services or feeders: installation, alteration, relocation
Ll-\...J
~ \1.(l~lJ"r ";:)rll1Vc...o.... \':1. I"W'-. --\tu "bvCI 200 amps or less (2) $ 81.00 $
PROPERTY OWNER I""" " 20 I to 400 amps (2) $ 95.00 $
Name: ,..ftA1...VJ rIVtJa, rvu="",,-,7 401 to 600 amps (2) $158,00 $
Address: Pi1 ~ ?>'iV 601 to 1,000 amps (2) $205.00 $
City: t:-Uc"c~ State:O)'t- I zIP:0f)t.({)J Over 1,000 amps or volts (2) $469.00 $
Phone: - , 1 Fax: - - Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87,00 $
property is not intended for sale, exchange, lease, or rent. OAR 401 to 600 amps (2)
479.540(1) and 479.560(1). $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
CONTRACTOR INSTALLATIO,N Branch circuits: new, alteration, extension per panel
Business name: f)mll d -4' '7J11 11 1'1-1'\ 011 a. Fee for branch circuits with purchase of a service or feeder fee:
Address: I C; -, ~. Lj" II 7::rf-, J Each branch circuit I $6.001$
City:c'")' 1Y: i'\ I\J] i ( rI State: (Jr2.. .1 ZIP: q 7(FRK b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: 5<-I1--=Jdl- 1{7<=>1 Fax: f'5b.Il-7L//-r,?:::Jr1' First branch circuit (2) $ 55.00 $
E-mail:tio.. {;J(),vd.1r1,. .^,.(= ~ ,A n" III'TVV\. Each additional branch circuit $ 6.00 $
CCB license no.: , gd7~ I BCD license no.: J Miscellaneous fees: service or feeder not included
Signing supervisor's license no,: \.l=s Cf,LEA Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: ta,y ( (')rv-, t 1 r . Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: f'.....,?7 /' r.J '-! c:.J/ Signal circuit or a limited-energy panel, t $ 63.00 $ ~'2.,
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
~~ APPLICANT USE
(A) Enter subtotal Of above fees $G-3 i-
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $,.':=>I.
~ {\\: (C) Technology Fee (5% of[AD $'~.\~
TOTAL fees and surcharges (A through C): $ ,,?:;,-'
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440,2584,) (9/08/COM)
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S!:RIN.G. FIEL~
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,~. OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
81lsPR2011-01637
400 INTERNATIONAL WAY
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541-726-3753
pelTTlitcenter@ci.springfield.or.us
RECEIPT NO: 2011001840 RECORD NO: 811-SPR2011-01637 DATE: 06/30/2011
tOES.CRII'.TION ~ " _'. "~"'\;",;' "';C.' 0 'f;~ACGOUNf:[cOOE.7':c'-'" .it "Z;'l\MOLJNtOUE" i' '.1
Fire Alarm 224-00000-426102 63,00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 7,56
Technology fee (5% of permit total) 100-00000-425605 3,15
TOTAL DUE: 73.71
[ pAYIvlENTfYPE~',,; PA YOR'"<-,;,' CASH)ER,CCARPENTER;:'COMI:!1ENTS;,c.. " 0"~;" ;-"A:lvlourtrPAIO;,i.,s,i.,
Check OMUD & SWINNEY FIRE $73.71
42151 PROTECTION & SECURITY INC
TOTAL PAID:
$73.71