HomeMy WebLinkAboutPermit Electrical 2011-7-11
225 Fifth Street. Springfield, OR 97477.PH(541)726-3753+FAX(541}726-3689
DEPARTMENT USE ONLY
Date: 7-11- ( 1
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.
, . ;EOCAL:;l;>O\lERNME~TAPPR.OVAI2',+'}'P ..
Zoning approval vetified? 0 Yes 0 No
,. '.'CATEGORY'OFCONSTRUC1JON,\
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Residential D Government D Commercial
[~:t'1rrt::;i'J,OB:~SITE: INFQR.MNtIQlilriANtl!iLfOc'A'tlONi,ti.'~1f: n
Job site address: t. IV; .4 ....e.
State: 6 ZIP:
Z- "3 ( '3 Taxlot.: OJ'ZI 0
DESCRIPTION OF' WORK ii,
re.hoe.
:'~..~-.?tY\i)i;;;::.'\1,::-~?~f;\~(;:Yf;'~E:~';fSCH E_D.W ~_E~Cj~;v;:;t(,;~~i~~"'i~l;f'h~~~~~i[)t!.~'!i
,Numbe, ?fi~spe~ti~'~s pe'it~~ 0 Qty. ,C.~~tl I~~~~I.,
Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: instalfation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
601 to 1,.000 amps (2) $205.00 $
")7l(7. Over 1 ,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Name: ':h "'1"
Address: S Z ':::::> I
City: ~ ~r "-
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 nol intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
Business name:t'c:
c
Phon
E-mail:
CCB license no.:1 ~2'7 BCD license no.: C-4'71
:3&.7.s
Prinl name of signing supervisor: v"'\",Tt- Gro.....~
. Signature of signing ~upervisor
ATTENTION: Oregon iaw requ~e~X~iii~y
follow rules adopted by the Or ~e set forth
Notification Center. Those ru~e~:R 952-001-
~o~~R ~;u2~~~-~gt~~~~~~i~S of the rUhles by
'. t r (Note: the telep one
callmg the cen e . Utility Notification
mber for the Oregon
n,u Center is 1_800-332-2344).
~.
~'t~
~~
~
440-2584-J (9/08/COM)
Temporary services or feeders: installa~ion, alteration, relocation
200 amps or less (2) $ 63.00 $
20 I 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. e:Y.;tension per panel
a. Fee for branch circuits with purchase of a se"rvice or feeder fee:
Each branch circuit
$ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
)
I
$ 55.00 $ OS )
$ 6.00 $ b
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limitedwenergy panel,
alt~ration, or extension (2)
$ 63.00
$ 63.00
$
$
$
$ 63.00
Each additional inspection: (I) '. "<,, "'~!!'bqp $
'~,:;;;;:i~i%~'JE;;,';fi;lij@;'A~e[:lc~ ~
(Aj\E~t~~'s'M~rtc1[,lJl,~k'-fe~t~\s ?E"'WI~ pfT" ..'
(lV!i,ii:;;um:J.er~t\'l~\S5&~); ^,,\f\O~ED fO I'> c: ~ l, (
(B)fErit~~!~t~\1~&t~.I?_x::tA]) ,or $ 77Z
(C) T;Hh1!~g-!lii Ii)F:(5o/.\;''i'rXj) $ -:>'"
TOT)\'L f~es and surcharges (A through C): $ -., ~ 'C-
..?
7/!1-
.
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
WWW.cLspringfield.or.us
811-SPR2011-01724
3251 VIRGINIA AVE
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001948 RECORD NO: 811-SPR2011-01724
tDESCRIR.1"ION~;7-; ,<- ,L '':It-5'-::rf':; -,,'C \,,"":"i~,;:L::..cAC:CODNt?i:;(foE;C'',-~;\ ,-..,:,_"
Branch circuits without service or feeder -1st circuit 224-00000-426102
Branch circuits without service or feeder - each additional 224-00000-426102
_________ _ _____ .____'"._. _.__._..,,____O"_.~
_ __ ~ta..t~3!_()r""go~~~ch_arge (13.'/, of appli."~~e-"~_..__._._~~~OgOOO-215004
.___::.ech~ology fee (5% of permit total) .._____._.......2gg:.9.9000:~5605 ____._
TOTAL DUE:
DATE: 07/11/2011
Al';foLHfllDUE .-," ':1
55.00
600
7.32
3.05
-_._---~
71.37
AMOUNTPAID:.'f
$71,37
illAYMENT TYRE
Credit Card
040540
"PA YOIF '::c" "CASHIER,oaOWLSBY' ,.- ': C0MMEN1"S~';"0 ";;.',"; .._" '"".;
" ' ,'-. -...~""...,' , .:,'~~,~;j;,~_~~_~~.~~~~' ,,;. 3. ,.~
COMPLETE ELECTRICAL
INSTALLATIONS INC
..:.:1
TOTAL PAID:
$71.37