HomeMy WebLinkAboutPermit Electrical 2011-6-16
EJedrical Permit Application
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225 Fifth Street. Springfield, OR 97477tPH(541)726-375H FAX(541)726-3689
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DEPARTMENT'USE ONLY
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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.
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Zoning approval verified? D Ves D No
:-.,j',' < <.CATEGORY,".OF.:CONSTRUCTION;,,7-.i
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.Number of inspection, per it~in(f., Qiy.
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Residential, per unit, service included:
Reference:
T~P
'PROPERTY OWNER
Name: l-\.-.t-y!:>c=N Uo"^",,,::>
Address: 2t.(&.<{sw C, ~11<: ~ p,--
City: Q=~ State: dJ<<--
Phone:S7((- 5Q. ~ Fax:
E-mail: . i+e-t>->O<Z.ACI's-o"'; (-HI, y~ - t<<ll"'-t:"::.
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) ;p~
Signature: 2-
.CONTRACTOR INSTALLATION
Business name: _____
Address:
City: ZIP:
Phone:
E-mail:
CCB license no.: ITL5''2Ct' BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Sig~ature of signing supervisor:
ATTENTION: Oregon taw requires youto
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth "V
In OAR 952-001-0010 through OAR 952-001- \)>' ^ ~
0090. You may obtain copies of the rules by {\'
calling the center. (Note: the tele~hone \9'
number for the Oregon Utility Notification ~~
Center is 1-800-332-2344). .,~
440-2584-J (9/08/COM)
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 amps (2)
601 to 1,000 amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
$ 81.00 $
$ 95.00 $
$158.00 $
$205.00 $
$469.00 $
$ 63.00 $
eration, relocation
200 amps or less (2) $ 63.00 $ (,
201 to 400 amps (2) $ 87.00 $
40 I 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
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit .
$
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder '}Ol included
Each pump or irriga~ion circle (2)
Each sign or outline lighting (2)
.$ 63.00 $
$ 63.00 $
Signal circuit or a limited-energy panel,
alteration, qr extension (2)
Each additional inspection: (I) $58.00 $
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$ 63.00
$
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-'i~\'. OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00774
4868 GLACIER DR
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541.726.3753
permitcenter@ci.springfield.or.us
.""C6.MI)lI.~NTS""~:1';-:
DATE: 06/16/2011
;;S~ l.~MOUNtOOE; -,
7.56
3.15
63.00
73.71
'.AMOUNTJ:>AID .... . "d
73.71
RECEIPT NO: 2011001656 RECORD NO: 811-SPR2011-00774
[DESCRIP..TION~':"t. ..:"",f. .,';'.7'71":;.'':' - ". ...~ACC00I\lJ&50E : ".<.... 5~
Slate of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology ree (5% of permit total) 100-00000-425605
Temp services 200 amps or less 224-00000-426102
TOTAL DUE:
L.~A..'fMg_NLtx.eE>~tJ,,,; Pt.. y'Q~<i.~SH]ER DB()WL~~ -,
Credit Card HAYDEN HOMES LLC
052308
''''''" '0.'
TOTAL PAID:
73.71