HomeMy WebLinkAboutPermit Electrical 2011-8-23
This permit is issued uuder OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days.
. 'EOCA.L;GOVERrilMElIITAI"PROVA"';,"'"c,."" '
Zoning approval verified? 0 Yes 0 No
;', 'CATEGORY~(()F.CONSTRUCTION . . .. "
.. .. .;:.
Electrical Permit Application.
225 Fifth Streett Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689
esidential 0 Government 0 Commercial
~~f'(i(013:~SIJE':INF()RNiATIONi'AlII[jML()_CATION\Wi;rn
Job site address: "6/50 SO. CST,
City: F State: ofL. ZIP: 7 7!
Reference: '70 Z- ':3 b 3 D Taxlot.DZKOD
. , DESCRIPTION, OF WORK '" . .
5ER.v)GE cH ~GE
PROPERTY OWNER
Name: A--IL 1?#\L Le-L&-c..,)
Address: :PO 'j?O,. 3z:.S
City: lJ/tLTi:'t..I/,UlE State: oL ZIP:77'f'
Phone:
Fax:
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:
. CONTRACTOR INSTALLATION
Business name: E't\S7SIDE [U3crl?lc.
Address: ~~.J.S3 80$GAGE L/J.
City: S-fYL9 State: oR ZIP: GiV 7~
Phone:S'/I-l'f..1- {vez~ Fax:SVI-736 y.q 6.0
E-mail: RIC:fCGf;<;i510€CSl.rf/.l{(JO.COM
CCB license no.: lilt 70 BCD license no.: :to -If (J 5' C. .
1.J.7J7s
ROG-GI?
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
. .rlV :\
\Y: !:\ ,\.;
~H~rl~E~MIT SHALL EXPIRE';F ~~~'~ORK ~,~
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR .
ANY 180 DAY PERIOD,' .
440-2584-) (9/08/COM)
. DEPARTMENT USE ONLY
Permit no. 5//- 0 (9'1 S-
Date:
'C';'\'::'.";:vf/;~:f4Wf~:{~\~,;,:r';~/~I5EE;~;SCH E_D.(Jt1I;:~:;:,ij;,i:~'>i~l<:;~~;~?}qt5~~~tt~~
Qty. Cost ,. Totatl
l"ea.) cos:
,J'Tu~ber' of ~nspe~tio'ns p~r..i.t~,in,' ()
'_ __'" _ ...._.."..,'.. "'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: instal/alion, alteration, relocation
200 amps or less (2) \ $ 81.00 $ ~I
20 I to 400 amps (2) $ 95.00 $
401 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) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration extension per panel
a. Fee for branch circuits with purchase.~f'a...'1'dr~e or feeder fee:
. , ..~(\U\\c: J .,"''''
.~~~,\~..cGcfi'i~~~\~~ tlie o(egr~::a~;~li6.00 $
I ;P;if<fflfpnmin~~r~~'\Withb1111{u)'fff~'birt'~~~i<:e or feeder fee:
Noplili.'b~~!'atiiFO!X\!9. In:U~\~'s 01 1\I,e 1~r:~(5500 $
\~~b_lOli!i'ilt!rli~'~W;il\'.In.e ;t~-\i~~li$;l\6.00 $
,_....JI:,.,n AAeL- "'\'1 \ Im\~Y' . .
Mio;<:w.....,Up} J.... flTr8ff;o,; 1~,,-i1J:L'!Piiv,cluded
E~If~Ii~p~~llti~n \;N2i~ (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limite,f..energy panel,
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
rrft(*(?1i&~~~:\t]t;~V~{~~~;~AReJj'CAN*~!lOSfY:i:~::~{:~::{;~!i;rKj,~,~!':':;~::.}.~'.'i'::'_~.,~
$ 63.00
$
(A) Enter subtotal of above fees
(Minimum Permit Fee S58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through C):
$,&/ ,00
$ r"z.
$ lfOS
$ <; ~ ."
, ,
.-:. .:._~
S!:=EL~
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~OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01995
81505 C ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011002306 RECORD NO: S11-SPR2011-01995 DATE: 08/23/2011
tbESCRIF>TION'.~~_c.: i'Ltt'l:_'--"~',_,:;~:_::;"{. '~~':::'f~."C:;ACc5uN:t:CODE.. ." .' .:(~i0WMOUNT"DLJE-'>'\.J
. _~".'::ic"s...?~gy_mJ.'~o~le:.ss__.______. _ ..____2~4-00000-4.?1?2.93____.._ 8100 ____
State of Oregon Surchar~::i23Olo of applicable fe~__.._.___. 821-00()Q0-21 ~___ ___. 9.72
Technology ree (5% of permit total) 100-00000-425605 4.05
TOTAL DUE: 94.77
f:"PAYMEN'r TYPEi>V
Credit Card
03504c
'PAYb'R,;~"'C.4:S'HIER';DCBowllsB'-:~'"~~~~-;:JT':':'c-O' MMENTSg;:~<2'>::;'~"'" 7"-':'~;<<}:;'+. AMOUNTPAI[)"#;:'~';,~~_:!_:!r,,_' '.' ,,,', -I
L...., ,,"'-; .- - ~...;., -~ ,_,~. "-'~- .,~." '" " " ", " ""~-"-""
roger king 94.77
TOTAL PAID:
94.77