HomeMy WebLinkAboutPermit Electrical 2009-7-31
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work' is not started within 180
d~ys of issuance or if work is suspended for 180 days.
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1 Zoning approval verified? 0 Yes 0 No
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1 Job site address: 207 7;2.:1.. ~;L I
1 City:),'rt"r. r'JJ I Stater0r 1 ZIP:q'7Lt7'? I
1 Subdi~ision:[ I Lot no.: I
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I Address: ~\ :'\ 1...,,0... ~-t 1
1 city: ~~NJ..kUld State: r)<[..1 ZIP: C\141~:
1 Phone. - f\a,") 54?lUlJax. -" '
I E~mail: 1
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).
Electrical Permit Application
D
225 Fifth Street. Springfield, OR 97477.PH(54t)726-3753+FAX(541)726-3689
Signature:
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Business name: jj? A P eJ ~ Jr",,.,"
1 A"ddress: !{?5? C<I~'C;'d", 0,,:
I City: $,;:-,,, 7r:~ ,J 1 State: 0 or
1 Phone: !>" 't - i :joS' --,-/(.,o( I Fax:
I E:mail: We..oG'<- t-'v1e, ~ 6)j~"",",c.v<:: 1:-. r1 e-f-
1 CCBlicenseno.: !'f)'f)57" 3 1 BCDlicenseno.:2GSi,S;
I Signing supervisor's license no.: C!Ct .n1 .e...
I print name of signing supervisor:WJJ.,,~ (L !A'lci _
,I Signarure of signing supervisor: /;( J. O} ,_ ("\J.. k___
1 ZIp:9777'?'
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I Residential, per unit, service include"d:
[1,000 sq, ft. or less (4)
'1 Each additional 500 sq, ft. or portion
thereof
1 limited energy (2)
lEach manufactured home or modular
dwelling service or feeder (2)
I Services or feeders: installation, alteration; relociltion
'1 200 amps or less (2) $ 81.00
1 201 to 400 amps (2) $ 95.00
I 401 to 600 amps (2) $158.00
I 601 to 1,000 amps (2) $205.00
lOver 1,000 amps or volts (2) $469.00
Reconnect only (2) I $ 63.00
I
1
I
I
1
1
1
1
I
I
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Temporary services or feeders: installation, alteration, relocation .1
1
1
1
1
1
I
1
1
1
I
1
1
I
$134.00
I $
1 $
$ 25.00
$ 32.00
$
$ 63.00
$
$
$
$
$
$
$
200 amps or less (2)
$ 63.00 $
201 to 400 amps (2) $ 87.00 $
1 401 to 600 amps (2) $126.00 $
.1 Over 600 amps or 1,000 volts, see services or feeders section above
I Branch circuits: new, alteration, extension per panel
1 a: Fee for branch circuits with purchase of a service or feeder fee:
I Each branch circuit ' I, '? 1 $ 6.00 1 $
1 b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
I Miscellaneous fees: service or feeder not included
1 Each pump or irrigation circle (2) $ 63.00
Each sign or outline lighting (2) $ 63.00
$
$
Signal circuit or a limited-energy panel, 1 $
alteration, or extension (2) $ 63.00
1 Each additional inspection: (I) ," $58.00 I $
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(A) Enter subtotal ofabove fees
<lI:"inimum Permit Fee $58.00)
1 (B) Enter 12% surcharge (.12 x [A])
1 (e) Technology Fee (5% of[A]) , 1
1 TOTAL fees and surcharges (A through C): I
$
$
$
$
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2.0 00 '
2AD ~1.'b~O
,.00
-
225 Fifth Street
Spri!1gfield, Oregon 97477
541-726-3759 Phone
Job/JOl~rnal,.Number
:R(i)'\l112'1i69!0002'1
~'~~MQM9!00028
11"li~.'_. _, I.
~~09~00028
Payments:
Typ~ ~f Payment
Check
cReceinll
RECEIPT #:
ii_
2200900000000001326
Description
Minimum/Adjustment Electrical
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DARWIN HOLBROOK
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 11/25/2009
11: 13: 15AM
Amount Due
20,00
1.00
2.40
$23.40
Item Total:
Check Number Authorization
Rec~ived By Batch Number Number How Received
KR
1173
A\+N:
L.l5cA ~~
Page 1 of 1
Arnollnt Paid
In Person
Payment Total:
$23.40
u;;M
11/25/2009