HomeMy WebLinkAboutPermit Electrical 2011-7-7
t .(
,~~~~~" ~~i@I~FYioNisRRrN6EluD'::@REG@~{~~~~if~>t~~J~
.:~f~: $'%'1\:.,J~:~L'iUf~'l{~,'ift~..-r"'~W\("'$',j'i:r" ~';7;" '.-~~', ,~(p(tp., ,~~ "'I."...... ~~~.j::v"'" ~.'.
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726:3689
ELECTRJCAL PERM'IT APPliCATION
City Job Number >11-0 170:5 Date /7/1/rr
I. t;t,q9:lP!~:jN@miN'~f1A.gwlQM:~~~~~~ 3.
L:~~:ESC:;;::;'f. . Y it /Ita pI( A. ~~ew.R~f;de~lia'F~rsiifgi~to~:Mufii~F~'Iriii~~~(d;.,~ml'fu~i,,:~'
/70 :3 :3 .; J I /0 t{ 0 () Service Included
JOB DESCRIPTION 1000 sq. ft. or less
. Each additional 500 sq. ft. or
C ;12(' I J ,. 15 Yd.;) {(, '-f(ll"", C P< r.1/ffenfPortion thereof. ,
Permits are uon-transferable and expire if work is Each Manufact'd Home or
not started within 180 days of issuance or if work is Modular Dwelling Service or
Suspended for 180 days. Feeder
$106.00
$ 19.00
$50.00
iU~> ",-, .', "'~1fID:r2ll:~n&"'1';i;"''''-''',r,~.,,:,~,it, ;,h ~;..)~t; "',_\"""""~J'ill''';'4f:' "I in'" ..:"n
B. ::Services,or":,Feeders,!.:~Installation;iAlterations~()r Reloc.iWin:" '"
"',: ,.,...V_-O._~l'" -",' ,', " ....,<). " j 'SlJWl.ti!1li\tuit'V' "1i"";..rNA'i;" ,:;~''''!''l''''' A:"" ,.;. .' ,. "'.~' . i
eo'NriiiAcToitw.vs1JAEfj}friJi(jN,'0NL~
2. . i.~"l:h"!';~i:t:'iCt"',l;,nL'....t/'jffiYtlf.i '.C' ,., ,,,.: ." "." ;'....","'"
Electrical Contractor 1}j('s G/C(J..Tte ,'~
9-5''7u'7
City I/Uft.0 c:.. Phone
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
. . 601 Amps to 1000 Amps
c;c/I - 93S-,2ISol';"1000Amps/Volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Address
Supervisor License Number kif ~ -:;
! D ~! - n /1/ Z-
Expiration Date "L-'-"L
---'
Constr. Contr. Number I 0 <J <;& L(
Expiration Date I ! ! Ij //3
Signature of Supervising Electrician
c. ;lre'mH9!;tg:jS_e,wi~'~~:roJi'Fe~'~'~~
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00 '
$100.00
Over 600 Amps or 1000 Volts see "B" above.
1'''''''jW'''''''~'~'',l''' "~'''i!ll!!''!t''~rm' "';;i r[dJ ;' .~
D. ~BrancJ)\'ejicUjts~-7f-'~';,~'" .{H~~fj}tW;i;:;. ,".fi':"'\'?>.;:.j7,)t'~?';~:~;"'1't';'r;;~~'4~_:-.~ f-'
,...-.,....."...~, """'~' "". ,,~-'~~'.h;.fm8i!}qh. ,,'d ..",l:i.( --., .:!~~"". &4r.A"'-.~,..::>- "', ~'''''',.! ~".:",.". "o~_'" ,...,,''''~
)J~ /~~
New Alteration or Extension Per panel/ S'r-
One Circuit $ 15.00 '5 ~-
Each Additional Circuit or with 5' fi'" '_.__,'50
Owners Name (,{ /"t1~ /JU~T' n s::c:o:::~:er:e~i: '. '" ,~ ''^ 11m' ~~.~~.G\~ '"
Address / / ----- c de- ,/.J. E. 'MiscellaneousT Seryicelfeeder it iUt u e cw' s :illation,:
. - 2- d- ~ . . ~ ~,- '" ti''C - ". ~ ,
j' - lrIn -- "7-/,/ ',A-! ~\01' "II S n 1\\1'5 ,,1'\\ I-
CIty /1l;1, )11l1.L.. ~ krone -S r' ~- ",,:Ittf1'-<j,(d'Zl'ump or In::ga~I1)I:?-w' \l~Dt.f' _ ~::-\1)$,5O:0n
if 'i'I tea.l.llle ~ 0\WW SlgnlOutline'i.ighting,ll1:D O?- IS 1'<0 $ 50.00
OWNER INSTAb\+.UOl'Pd(l ~~ IDe Ole;f~ sel IO~~ LimIted EnJ~~;J~~iae"r\tiiJ~J ?'2\\IO\). $ 25.00
O'\',,~\I I' dollle ~e(\.lleS o.9S'2.'() , \,1.11''''':" n~J
The IOst~JatI-~n is\b,;;n~madeo\V~''rop~il)O'wn WhiCh, 'o'j LimIted EnergyiColl)l!1efCIal , $ 45.00
. \"\\(;) 1- ~ \),,,Y. <0"'" I IDe' V' 1-\\'11
IS not 10 en~tl,.J'I!taa~o\~~t:~ 'allies 0 lellDO(le Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
~O~~'" 95'2.- a" o\llal(l,~ole' IDe ~~O\I\\ca\\O(l ~. '~'"' ' ,'L,f.." . ~',"~.. '," '" oS
Owners Sl urqbIJ ((\ "e(llet. \ "\II\W " ') 4. 'SUBTOTA!L OE,itBOVE~?"',1f:~~"}.;' {' ,~: D \
o 9. ne c 900 v 2-'3A'-\-' !il';. 1..['Ii)!',! IW ,'Y "' H ""--I;-r~ 'f~ IWi fi'iJ.-;, ~; It."
calli(l9 I IDe ore 00-33'2.- "",-"" 0
~\')el 101 '^' is '\ -<I ...t\ I (Z 1/",10 State Surcharge 10 Z
"V" Ge'."" ~''k\\;J W%-Administrattve-Fee- 'I ?F
..~.... R~~, n",,,, \\f 'fo,~::,,";,,;",_,_ ~'^""_~::-
;
4
S;~~~G..~~.L~
~... NIAL
'" ,-
C,,, m OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726.3753
www.ci.springfield.or.us
811-SPR2011-01703
115 S 5TH ST
permitcenter@ci,springfield.or.us
RECEIPT NO: 2011001916 RECORD NO: 811.SPR2011-01703 DATE: 07/07/2011
iDESCRIP.,TION .Ii . . . . ..: .r.,. :c.'"-:~:;.:.L___:.c~AcCOUNTcCODE,-....,.;. '"' . . I'.IVfOUN:tDUE...:.-': I
Branch circuits without service or feeder. 1st circuit 224.00000.426102 55.00
w__~
Branch circuits without service or feeder - each additional 224-00000-426102 30.00
State of Oregon Surcharge (12% of applicable fees) 821-00000.215004 10.20
Technology fee (5% of permit total) 100-00000-425605 4.25
TOTAL DUE: 99.45
[ flAY. MENTT.YPP.Y), . PAYOFf "I.,J.cAs':"rER~DBOWU5By''\R.ic6MMENT'''''S' "t.~.'C."... . ",,-:-r AMOUNT PAID .
'. .;';;_' ~ '"-",,, __ _0' . '~'~'~',~ , . ""~"'''''~'"'''' :', '~"'..O,'".,:,'" '. .. .....
Check PHANTOM INC $99.45
2035
TOTAL PAID:
$99.45