HomeMy WebLinkAboutPermit Electrical 2011-7-6
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Electrical Permit Application
225 Fifth Streett Springfield, OR 97477 +PH(54l)726-3753+ FAX(54 1)726-3689
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. bEP~RTMENT USE ONLY
Permil no.: 51/-oobzb
,
Dale: 7- 6. -(I
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~G()VERNMENT 'APPB,OVAlfi.,. .', ' ,
Zoning approval verified? DYes D No
. ,CATEGORYC()f, . CONSTRUCTION)! "':.
Residential 0 Government 0 Commercial
~r;1:6:~~OB;;iSITEi;.INF()RMAmIQN;.AN[j!,IiP'CATION~!iit~T"
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City: State: of?..
7'0 22.\ L Taxlot.:O( ]'DJ
. DESCRIPTION OF WORK i.', ,,',,' ,)
0"" - c.,rc...;\-;-
Name:
Address:
City:
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 INSTALLATION
Business name: E.' ~S 1S wE ~U;C1fUc
Address 5'(;JS3 805CAGe L/J.
City: 5r~1.9 State: oR. ZIP: G,V 7~
Phone:S'/I-1~1- {V"I€( Fax:SV/- 736 y.q (;0
E-mail: R{<:KGf..Si510€Ql.(Ii.to(OO.C0I4
CCB license no.: [ It 17 0
Signing supervisor's license no,:
Print name of signing supervisor:
BCD license no.: J.6 -y (J ') C .
<.(7)'5
ROG.GI? I:::,,,,r;.
Signature of signing supervisor:
On law requIre
A1TENTION: rego b the Oregon Utility
folloW rules adoPte~hJse rules are set forth
Notification cente~10 through OAR 952-001-
In OAR 952-001-0 .' co ies of the rules by
0090. You may obtain Nofe: the telephOne () "
calling the center. (on Utility Notification \ ~y
numberfor the,O~~€00_332-2344), \)oJ", .\\
Center IS I .?
\P
440-2584-J (9/08/COM)
:'i~'<':',;_:'~';'4;.i'fi",;~.~,$ih\~:~\~~2~f1f.I:E")i'SpR E[jl~lJl;~:;.'~i~,it~:;Ntf{;J~?f.~~J,~~j~~\~~
Num~er 6qn;pe~iionsperite~ 6' 'diy,
", "-" ' . - ,:..;.,'..,. '.... "!""',' ..
Residential, per unit, service included:
Cost Total
;-'ea; cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
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)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 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 Of feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$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
I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circ.uit,(2)
$ 55.00
$)<'
$
Each additional branch circuit .' "' $ 6.00
Miscellaneous fees: service or feeder nor~ne{~~fA\
N :;E~llli~Wnp or lr<;ig~\i~n 'E'ygreV2} If I' ; \S i'l$)1;3:00
1 ~1?~d;>f.~Jj\)1qilHi'f\,&\tJf,'g\{~':.':~:~1 \ fOl $63.00
I \.slgfi~l~~~~i!.'PlI'\\irW;~n%~~el" $ 63.00 $
\' ,'!f!".!\1}2Q~o;:exten~i,qq~\'f\
'. ,,'\"Oc'l,r,'-"
",~Nh1aoaitr()nal inspection: (1) $58.00 $
(:~~t~:~,~{if0g;~gHS~~W~;f:_~~1(AR~:D"ic:ptNTi,'~_.DS'Et"ji~:i;:"'~ft:'~;!~;~~,~"~'&,\U;~Y','t:" '; -
$
$
(A) Enter subtotal of above rees
(Minimum Permit F~8.-Q.QY
(B) Enter 12% surcharge (.12 x [A])
(C) Technology Fee (5% of [A])
TOTAL fees and surcharges (A througb C):
$ ~6
$ b 10
$ 190
$ / ...,J::I.L...
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"~;OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541~726~3753
www.cLspringfield.or.us
811-SPR2011-00626
617 COLONIAL DR
permitcenter@cLspringfield.or.us
DATE: 07/06/2011
','C,;:;'::;' ';t"AIVIOuNrj:>UE.:-.....' o. 1
3.00
55.00
696
290
--"-~-~-"-"'-~.,-~._--
TOTAL DUE: 67.86
1'<pAYMENF'f;YPE4":.pAY0f(l':.Z';:";cASHIERHilBOWLSBY '''.'tCOMIVIENjfS'~:;;:.'.: ;.;; .'.' ..'/.AlVIoaN:I;PAlljf~;;. .
~., ..-i.' '__. ~ .. '-~ .. ", '..,' -..-.. .. .. ... .. ,." ..
Credit Card mark mulholland $67.86
RECEIPT NO: 2011001898 RECORD NO: 811.SPR2011.00626
) , ".. .....,... ............y.........v '," ", ~ ~ ",' .,.JFf";.....,: .:.....~-,.: >_, ."". ',"" -:.,- " ......:/,.. '.....T. .. ,.........F............T.. "......"
IDESCRI~TION....~.l_~...~.~;.~:.,;, .....';.;a.:..::..;;.i".y. .'~J ].ACCQUNT:CODE
Balance of Minimum Electrical Permit Fees 224-00000-426102
---- ~
Branch circuits without service or feeder ~ 1st circuit 224-00000~426102
821-00000-215004
100-00000-425605
State of Oregon Surcharg~(12% of applicable fees)
Technology fee (5% of permit total)
. .\
045939
TOTAL PAID:
$67.86
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