HomeMy WebLinkAboutPermit Electrical 2011-8-23
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Electrical Permit Application
r~j;r~(Of S.rRINGtr~LP/O~E.G9~iF
225 Fifth Street+Springfield, OR 97477+ PII(541)726-37S3+ FAX(541)726-3689
DEPARTMENT USE ONLY
SPRINGFIELD r-
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~'''r'~,,~ Permit no,: 9/- 0 { 7 Z-
Date: 'Z ~ 2 3 ~ / /
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.
CONTRACTOR INSTAllATION
Business name: A-L cLELTf2/GII}\'
Address: Po 'D. ~ l-\l3B'1'
City: ;:;tLb. I State: 19 e.. ZIP: 9 7'10'1
Phone: 74i bOC, - (717 I Fax: . -
E-mail: cflbvo \>,},p'~ C" C>.-tf'II-Sr. p,)6~
CCB license no,:/'19 if :2 t- I BCD license no,: ZD -1f7i{C
~ Lf5A9LS
Bl2-Y/}t,J ,-. fffllZie!
Signature of signing supervisor: 1f<.A. L. 17 1/, f A
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" ',' . ORK .:, 'APPLICANT USE
N01\CE: \.. 8ZPIRE If 1\1E \N 1 . O~~g&'F\~~btb?a1.'d~rb3~t5l'l\iW
HilS PERM\1 S\-\fl,~R 11-1\S PERMIT IS NO AT1EN1\O~. ;(\V,t'l!!!'4J~o 'i1<'t~~~~~ ~lbQ%rth_
fl,UTI-IORIZED UND S ABANDONED fOR.. lo\l~W rule C #(\U:nt;!iWl%1~\~1erAIf{~15~lflHL
MENCED OR \ (l , Not\1lcattOn r .{\<ff ,- 'lI;yj I 0
COM fl,Y PERIOD. \ ~\./ \...~lnOAR952-0 lq'f~:\Mqi?~€:~ :~:[it,:'
ANY '\ 80 D \)U~~~t>-. 0090. '(outhme ~"'rii't4 L((e.es,"R~~'urghAFg~~\(A)tl1rough C):
ca\\\ng v 0 gOD u\. InI . .
mber lor the. re 800_332-2344).
nLl center IS '\-
440-2584.' (9I08/COM)
~.
lOCAL GOVERNMENT APPROVAL
Zoning approval veri lied? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
~sidential I D Government I D Commercial
JOB SITE INFORMATION AND lOCATION
Job site address: '7 2 q fi, ~. ST
City: sR".e.1 ()u \=i..e\& I State: DOL. zlpQ7/7l3..
Reference: \~' -"" \ I Taxlot.: \Illofl )
'. DESCRIPTION OF WORK
f2-<.>1."~",,l A- DDXo.J
PROPERTY OWNER. '
)C /11lA V<f-./I I w~ cd t71 fL
72'7X E' s.f-
'> Pt~ C, I State:",,^- ZIP: '77V7t
- - I Fax: - -
Name:
Address:
City:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member cfmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
Signing supervisor's license no.:
Print name of signing supervisor:
FEE SCHEDULE
Numbcl',of inspections per item () Qty. Cost Total
ea. 'cost
Residential, per unit, scn'ice included:
1,000 sq, ft. or less (4) $134.00 $
Each additional 500 sq. n. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manu factured home or modular $ 63.00 $
dwelling service or feeder (2)
Scn'iccs or feeders: ins/allation. aI/era/ion, relocation
200 amps or less (2) / $ 81.00 $ rr/
20 I to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601'01,000 amps (2) $20S.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temponlry sen'ices or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
40 I '0600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over 600 amps or 1.000 volts, see services or feeders section above
BnlOch circuits: new, alteration, eXlension per panel
a. Fcc for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 I $
b. Fee for branch circuits without purchase of a service or fceder fee:
First branch circuit (2)
$ 55.00
$ 6.00
$
$z,4
Each additional bram:h circuit
L(
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign o'r outline lighting (2)
$ 63.00 $
$ 63.00 $
$ 63.00 $
$58.00 $
f
Signal circuit or illimitcd-energy panel.
.-alteration, or extension (2)
Each additional inspection: (I)
$ 10S
$f2t:P
$ .s;:Z-)
$}ng5
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.
SP~~N~~~
.~ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541.726-3753
www.ci.springfietd.or.us
811-SPR2011-01728
7298 B ST
perm ilee nter@ci,springfield.or,us
"..---:..Accou NT~CODE
224-00000-426102
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
DATE: 08/23/2011
AMOUNT.DUE
24.00
81.00
12.60
5.25
122.85
AMOUNT PAID
122.85
.1
RECEIPT NO: 2011002295
lbESCRIP..TION" .,
Branch circuits with service or feeder each circuit
RECORD NO: 811-SPR2011-01728
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit tolal)
LP.AYM.ENT):'1:['E----1'AY.OR CASHIER: OBOWLSBY
Credit Card bryan hurley
02395b
C.OIVI.MENTS
TOTAL PAID:
122.85