HomeMy WebLinkAboutPermit Electrical 2019-01-24~ Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
::?::?S Fifth Srreere Springfield, OR 9747i • PH(S41)726-3753• FAX(541)726-3689
[ DEPARTMENT USE ONLY
~~ i Pemti'"o BrCDO/%
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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.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes O No
CATEGORY OF CONSTRUCTION
Residential j O Government I O Commercial
JOB SITE INFORMATION AND LOCATION
City::wc,n~1'dT ] state: OR I ZIP:"' 74 7 7
f
Taxlot.:
DESCRIPTIOfll OF W ORK
This installation is being made on residential or farm property
owned by me or a member ofmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.: BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
FEE SCHEDULE I
Number of inspections per item () Qty.I Cost Total
ea. cost
[ Residential, per unit, service included:
I L000 sq. ft. or less ( 4) i $181.00 $
I
Each additional 500 sq. ft. or portion $ 35.00 I $ thereof
Limited energy (2) $ 43.00 $
Each manufacrured home or modular $ 86.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) l $ 109.00 $
201 to 400 amps (2) $127.00 $
401 to 600 amps (2) $215.00 $
601 to 1,000 amps (2) $277.00 $
Over 1,000 amps or volts (2) $635.00 $
Reconnect only (2) $ 86.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) $ 86.00 $
201 to 400 amps (2) $ 118.00 $
401 to 600 amps (2) $172.00 $
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 of a service or feeder fee:
Each branch circuit $ 7.42 $
b: Fee for branch circuits withoutpurchase of a service or feeder fee:
First branch circuit (2) $ 86.00 $
Each additional branch circuit $ 7.42 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 86.00 $
Each sign or outline lighting (2) $ 99.00 $
Signal circuit or a limited-energy panel, $ 99.00 $
alteration, or extension (2)
Each additional inspection: (I) $99.00 $
J•: •'."·/Iie'\;J{\\,\V f)DEF!ARTMENT··-•USE:f;.{ff\fiiift{t\//i:;~'l•i:~
(A) Enter subtotal of above fees $
(Minimum Permit Fee $99.00)
(B) Enter 12% surcharge (.12 x [A]) $
(C) Technology Fee (5% of[A]) $
TOTAL fees and surcharges (A through D): $
Last edited 7/1/2018 BJones
P ro p e rty O w n e r S tatem e n t
R e g a rd in g C o n stru ctio n R es p o n sib ilitie s
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.325 (2))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
D I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
D I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
Print Name of~ · - -·-----
~ .i=? /~ I /2 3({q
SignaturefPermit Applicant Date
Permit#:
Address:
Issued by: _ Date: _
This Copy for Permit Offices