HomeMy WebLinkAboutPermit Electrical 2011-7-21
225 F;fth Street. Springfield, OR 97477'PH(541)726-3753+FAX(541)726-3689
DEPARTMENT USE ONLY
Date:
C\~
fl.'L\. \\
This permit is issued uuder 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'GOVERNMENTAppROV Al.' .,.e','" ,.'
Zoning approval veri lied? 0 Yes 0 No
:"".'.,.' ',:CATEGORV.QFCONSTRUCTION:.> ..
~~~~~:~ITEJ'IN~~R~A;7;N~tAN[j[;~~C;~;;;~r;;~~it(i'
Job site...i!.ddress: ~ -,,~ ,\/'i, 1""\1 \. ~ \. ~
City: ...-")l V\ ~ lA' ~~. t ~ZIP: 0\.\-"
Reference: ' r:f1.,./~JL -\ JI Taxlot(J:1~ 1
. DESCRIPTION Of WORK 'c. .;.' '(." '-'
Q 0 {)!'c " S\.. So If\., (PO {\ N\f\
.....j ~. \" '1\ n.. I C'\n K'(\ nf7
PROPERTY OWNER 1'\
Name ~r\" 0 ~ . 'I A""""' \ .::!:31l ) -~ 0 ~ i?,/
Address: ~-'\-\. ~ '\ Iffa .~. . .t:t i"5<j-
City: ~ K./ State:no<.\J ZIP:U.~~'\
:'\ \'\',f\ YI\I'\~ - -
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:
~-,:~" -.:<:Vhi;~~~~y~tr-~:Nj.zW;<'f;'~EE~;:SCH'E_[j.Q GEfW:~lY;:\~f70;;?~:~f~~1~~~~;'~~:~#~
Nu~.~er'o.Onspe.~ti~.'~~s pe~,j,te,?' () .,
Residential, pe~ unit, service included:
Qty. Cost Total
;,"ea. ' cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
1,000 sq. ft. or less (4)
Each additional 500 sq.
thereof
-c ~imited energy (2)
ft. or portion
Each manufactured home or modular
dwelling service or feeder (2)
Serv'ices or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
60 I to 1.000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only .(2) l $ 63.00 $ln~.<<:V
Temporary services or 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
.-CONTRACTOR INSTALLATION Branch circuits: new, alteration. extension per panel
Business name: - /~/'RJ!..i7l5 N El'''' .t... 'r a. Fee for branch circuits with purchase ofa service or feeder fee:
Address: VcD p--cJ-.,c , /' Each branch circuit $ 6.00 $
City: ~ r PA4 "'" .StateO~ ZIP: Y'"/C/,9r; b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: ~ -95--:' -(Xl:;? Fax: - 7fRb-ij/~) First branch circuit (2) $ 55.00 $
E-mail: roc}.i.4~.fJ.orbJ.-j-Q.Ir::.d C iI1a ';'; . c-<!Y '\ Each additional branch circuit $ 6.00 $
CCB license no.+Jh ~ ./9 BCD license no.: Miscellaneous fees: service or feeder t!o~ included
Signing supervisor's license no.: "5 c..CJ 17 S Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor: """1(t9C):'v{ 'TherV' <-Y~ Ea~ignor outline lighting (2) $ 63.00
Signature of signing supervisor: A:J.-.:/X"" /1 1_ d., ~l~ circuit or a limited.energy panel, $ 63.00 $
/1 V L ratIon, or extenslOn (2)
..-r ~ "C7 Each additional inspection: (I) $58.00 $
:: to-... 0 ./ :j'f.;~;!i,~1*11\YJ;i;'.~i1g;;~;'AB,,'1.icANt!jiOSE(3];t::lj:li)'!{l'~:i\Y):<,
~ft..l'i. ~\ '~. \ \ (~i~::r~u~~:~i~f;:'O;;:~;) $: lc~~ ..' r:::P\ D~_
-1/\ (B) Enter 12% surcharge (.12 x [A]) . 1.'::1 u
(e) Technology Fee (5% of [A])
~ TOTAL fees and surcharges (A through C): $t'\~:rl (
o\\~~\
440-2584-J (9/08/COM)
$
$
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01793
4475 DAISY ST, SPACE 134
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011002085
lDES<i)lili3.i;IOI'lH:":';',
Service reconnect only
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-01793 DATE: 07/21/2011
" '" C:i:! mnmnl1iiilll'llliilil:lllll1iili11llIfii'':'I'/ i"'i{IIII'In'lIl.~_cno@jfLCs:.fo".",,' ii''. ~lIIio.aNjflD]J:~IIIIIH.llllllllillliillilll
224-00000-426102 63.00
821-00000-215004 7.56
100-00000-425605 3.15
TOTAL DUE: 73.71
PAYMEi,jjTI'iiII\{PE1mUiipA;y,eRii,',iii:,1iHjc!:sHlERCl"LBOifF1E!!11ilI.n:Qe:MiI1ie"r;j;ifS!1llBlll!ilF;jjlilliili1IiiHiI!ii1~II:lifJh1iftAM0U'I'lT~IiP;Il:l:illli1llllll'I!:IIi!;ilJ
Credit Card THORNTON ELECTRIC INC $73.71
511251
TOTAL PAID:
$73.71