The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2014-07-21Electrical Permit Application SPNINGFIELD F " 225 Fifth Street♦Springfield, Oil 97477 #PH(541)726-37530 I>AX(541)726-3689 I DEPARTMENT USE ONLY Permit no.: & ` /�S / Date: %/� / This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if worn is not started within 180 days of issuance or if work is suspended for 180 days. LOCALGOVERNMENT APPROVAL Zoning approval verified? ❑ Yes ❑ No CATEGORY OF CONSTRUCTION ❑ Residential - 10 Oovenunent X Commercial JOB SITE INFORMATION AND 'LOCATION Job site address: 3333 Riverbend Drive City: Springfield State: Oregon Z.IP: 87477 Reference: I Taxlot.: DESCRIPTION iOF WORK New feeder and branch circuits for new MRI machine _-_-- PROPERTY `OWNER Name: Sacred Heart Medical Center Address: 3333 Riverhead Drive City: Springfield State: Oregon ZIP: 97477 Pliome:641-222-7300 Fax: - - E-mail: This installation is being made on residential or farm property owned by me or a member of any 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: Oregon Electric Group Address: 483 Shelley Street City: Springfield State: Oregon "ZIP: 97477 Phone: 641-747-0811 1 Pax: 541-747-0862 E-mail: Doug. Alletsftrelion-electric.com CCB license no.: 203 1 BCD license no.: 26.96C Signing supervisor's license no.: 28438 Print name of signing supervisor: 7p c I r~ tS Signature of signing supervisor: ) U 410-2554-J (5/212014/CONI) FEE SCHEDULE 'Number of inspections per item O Qty. Cost ea. I Total cost: Residential, per unit, service included: 1,000 sq. R. or less (4) $161.00 S Each additional 500 sq. 0. or portion -thereof -------------_- § 28.00 ----- - S - Limited energy (2) _-_-- § 36.00 S Bach manufactured hone or modular dwolling service or feeder (2) § 71,00 S Services or feeders: installation, aberarior, relocation 200 amps or less (2) 1 § 91.00 $91.00 201 to 400 amps (2) $106.00 $ 401 to 600 amps (2) $178.00 $ 601 to 1,000 amps (2) 5230.00 S Over 1,000 amps or volts (2) $627.00 $ Reconnect only (2) $ 71.00 $ Temporary services or feeders: lnciallalion. alteration, relacntion 200 amps or less (2) $ 71.00 $ 201 to 400 amps (2) $ 98.00 $ 401 to 600 amps (2) $142.00 S Over 600 amps or 1,000 volts, see services or feeders section above Branch circuits: near• alteration. extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit 20 1 $ 7.00 1 $140 b. Fee for branch circuits without purchase of service or feeder fee: First branch circuit (2) $ 62.00 $ F.ach additional branch circuit $ 7.00 nfiscellaneous fees: se)Wc•e orjeeder not inchided Bach pump or irrigation circle (2) $ 71.00 $ Each sign or outline lighting (2) S 71.00 $ Signal circuit or a limited -energy panel. alteration, or extension (2) 1 $ 82.00 $82.00 Each additional inspection: (1) $82.00 $ APPLICANT USE (A) Enter subtotal of above fees (Minimum Permit Fee S82.00) 5313.00 (B) Enter 12%surcharge (.12 x [AJ) 537.66 (C) Technology Fee (5% of [A]) S16.66 (D) Continuing Education Fee $2.50 $2.60 TOTAL fees and surcharges (A through D): $368.71 SPRINGFIELD- CITY OF SPRINGFIELD -- �; , TRANSACTION RECEIPT 225 Fifth St Spdngfield,OR97477 `�'EGON 541-726-3753 811-SPR2014.01557 wvnv.spdngfield�r.gov 3333 RIVERBEND DR permitcenter@sp6ngfield-ocgov RECEIPT NO: 2014001623 RECORD NO: 811-SPR2014.01557 DATE: 07/28/2014 rMES1 PE15 1 Branch circuits with service or feeder each circuit 224-00000-426102 1004 140.00 Electrical Continuing Education fee 224-00000-425606 1032 2.50 Other Limited Energy 224-00000-426102 1004 82.00 Services 200 amps or less 224-00000-426102 1004 91.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 37.56 Technology fee (5% of permit total) 100-00000-425605 2099 15.65 TOTAL DUE: 368.71 ENTE.. Check GREENBERRY CONSTRUCTION LLC 368.71 22710 TOTAL PAID: 368.71 SPRINGFIELD ---- CITY OF SPRINGFIELD 225 Fifth St t TRANSACTION RECEIPT Spdnglield,OR 97477 OREGON 541-726-3753 811-SPR2014-01557 w .spdngfieldocgov 3333 RIVERBEND DR permitcenter@spdngneld-ocgov RECEIPT NO: 2014001623 RECORD NO: 811-SPR2014.01557 DATE: 07/28/2014 -_ Branch circuits with service or feeder each circuit 224-00000-426102 1004 140.00 Electrical Continuing Education fee 224-00000-425606 1032 2,50 Other Limited Energy 224-00000-426102 1004 82,00 Services 200 amps or less 224-00000-426102 1004 91.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099 37.56 Technology fee (5% of permit total) 100-00000-425605 2099 15.65 TOTAL DUE: 368.71 Check GREENBERRY CONSTRUCTION LLC 368.71 22710 TOTAL PAID: 368.71