HomeMy WebLinkAboutPermit Electrical 2011-7-7
Electrical Permit Application
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225 Fiflh Street+SpTingfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
;!?~P,A~lo/1E~J U,SE ONLY,
Permit no.: <; //- /1018'
Date: 7- 7-//
This permit is issued under OAR 9\8-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for \80 days.
,;:!~;~t1ii,\t'::;LOCA~:'GOVERNMEN1;,,'AP,P,ROVAt'::"'\','O: i', .' ';':,;f'(!;;:'!;~~;;;:.~,!f,EE 'SCHEDULE , ; "
Zoning approval verified? DYes DNo ';~,".'j,*';~"\,:~~:~; ~\':":_>r,;:'\':-,l'i;\'''~'",' '," ;,_(;e ;"''<~ ~';'-__" , ' Qty. CoSt Total
Nu'mli'if:'oftinspeCtioDS per item'( )
'),.;:!j!t,jp,.,,,,,,:CAl"EGORY,iOF~CONSl"RUCl"ION;,,:; '.;:.(.', ,,"'I', i{i;";"::-.t..:o_"",~":,,;,,,,.;;,,,, "....,,.,., '-..J.'l,' :' '- . ',. ,'.:.<'... ') ea. cost
o Residential I 0 Government I ~Commercial Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
.,Ai";,;:;JOB ,'SITE INFORMA l"IONAND~,LOCA TION ,;;"'.
Job site address: /dO",>, (1J""tJ1if('.A.uJ/ A-I/l- Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City: CJ)r /-- 4. ,Au< I State: 01( I ZIP: 'Ii/17ft Limited energy (2) $ 32.00 $
Subdivision: V '\'10'8\ \<\ I Lot no.:O<I rYY'l Each manufactured home or modular $ 63.00 $
, I' :<';[:;;;;;;:(,~ij;:\"f.'iijDESCRIP,l"ION:OF~WORK;'~.3j,,'; ,~:; ,:;';' dwelling service or feeder (2)
I tIJJ feJev-s FfJ,;" bI.....,t/t' P"Mt--I..tf-f. Df-z.bf- es or feeders: installation, alteration, relocation
200/amps or less (2) , $ ?"2)J . '!i<--
~ Vrw1..1. c-i"..;..ITAu b/l..mvs +-#~. LJ $ 81.00
:"'::',;:"i", : ,.":,,,.:: :PRClPE~l"W' OWNER'""",,""" "\"":C' ",",;':;\.,: 201 to 400 amps (2) $ 95.00 $
> ..,'.'.'.. ~'j).,.,.;...,t:'),...,1 , .. ,..,... '; \;,_.. ... . .t:*-./:,':;' G";-""';.';';~:'l. f. .:".;'
Name: J:::",,,h i',).c rlIAMh.} ,-, ~ wrr-h 401 to 600 amps (2) $158,00 $
Address: /,/Ol{t::;" I LJ 101t~ ~~ $1. 601 to 1,000 amps (2) $205.00 $
City:5"l"/..tll/~.A I State: 01<. I ZIP:17lf"le: Over 1,000 ainps or volts (2) $469.00 $
Phone: , I 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 40 I [0 600 amps (2)
479.540(1) and 479.560(1). ' $126.00 $
Signature: Over 600 amps or LOOO,volts, see services or feeders section ahove
:.';'~;';:iJ~P':2}CONTRACl"OR,:INSJ AI&Al"ION;';''' '~', " :'~,,^ Branch circuits: new, alteration, extension per panel
Business name: !\ 0 J I \ (1)f) J / J: J I .fiT H .;. , a. Fee for branch circuits with purc,hase of a service or feeder fee: ..
Address: -OD /,1,...1 -9/~'n3 Each branch circuit SI $ 6.00 $ ,oil
City;?/ I /'l11 /Wn I State:!'J1" ' I zlpQ-7'1 ():;L b. Fee for branch circuits without purchase of a service or feeder fee:
Phone:~47 -68t:,.,:J:::tlt!)1 Fax:~q/M~ - - First branch circuit (2) $ 55.00 $
E-maid . -+. -I;) ..." 1..lnd Jo}gjl-r. :"'.' Each additional branc.h circuit $ 6.00 $
CCB license no.: 5m x>!!? 1 BCD license nobD-J ds7 Miscellaneous fees: se0'ice or feeder not included
Signing supervisor's license no.: _,,>,;1:S,:J S - Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisol\\. L,."-. ~ ~ ;;:" Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: ~ .p'~ __ I Signal circuit or a limited-energy panel, $ 63.00 $
V '/ alteration, or extension (2)
Each additional inspection: (I) $58.00 $
~~~,tfJfJ1~l{1~~~~~lAFf~IUCANjJ~OSE'~i:~~~~\~;';j\.~~Ir;;cl:;:':
\^-~\iJ (A) Enter subtotal of above fees ISo-' y
(Minimum Permit Fce $58.00) $
"\. ~ (8) Enter 12% surcharge (.12 x IA]) $ 75 ~ ~
1\~ (C) Technology Fec (5% oflA]) $ 1/V
TOTAL fees and surcharges (A through C): $ 117 ~
r11Ab ts"% 11-li1~/~ Plu-1 AC~I'vJ /rl. s-o
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440.2584-) (9/08/COM)
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,:<;";> .OREGOH
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth $t
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01698
4045 COMMERCIAL AVE
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001915 RECORD NO: 811-SPR2011-01698 DATE: 07/07/2011
lP.ES:GRIr?;1iION.,;;",ii;""":i'iiiiii:iiiiii.i:,:"",,,.:.. .:"!I'lii~~I"""illJli1lIIIiiIiii:iimli,iII1I..liiIiIii~lFg.c:ci:>J!iRfJl:c_QP1~li!I!~"jiLN~;;i!hl:;lFiiilii"i'i";8Niol!.ijijjf*DXjt1!illJm"
!:!mli,,,,,J;~
Branch circuits with service or leeder each circuit 224-00000-426102 306.00
Electrical Plan Review (25% 01 electrical lee) 224-00000-426102 157.50
Services 200 amps or less 224-00000-426102 324.00
State 01 Oregon Surcharge (12% 01 applicable lees) 821-00000-215004 75.60
Technology lee (5% 01 penni! t.otal) 100-00000-425605 .31.50
TOTAL DUE: 894.60
I.. "PAYMENm;,iliMpEi,ii!ii.,H..PAYORlIi'!!IIWillii'A~Ii!E~iilH9IlftERJII.WiCOMNiENTS1l!1~~.I!!i!ffliililiiiGUliii:1lJ:!'!I'!IiAM0I!.iN:ijFj~IG~~!!!;;~;:1':!!'1
Credit Card NEW WAY ELECTRIC INC $894.60
517061
TOTAL PAID:
$894.60