HomeMy WebLinkAboutPermit Electrical 2010-8-23
. Electrical Permit Application
1~<IDI1~~
225 Fifth Strret.Springfield. OR 97477.PH(S41)726-J75J.FAX(541)726-3689
I~
DEPARTMENT USE ONLY
sf.eu>cc..')~oo {( C
Permit no.:
Date: 8~Z! -/0
This permit is issued uuder OAR 918-309-0000. Permits are nontransferable. Permits expire If work is not started witbin 180
days onssuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Residential ~ Government 0 Commercial
JOB SiTE INFORMATION AND LOCATION
Job site address: 2..15 c.. 8T E: eT
City:S rif'\ 'e,\ State: D ZIP: 7 7
Reference: I () s;J S z..'S Taxlot: It! c) 0
DESCRIPTiON OF WORK
n Ii
rn$ .
PROPERTY OWNER
Name: [ i
250 6 .Sf
City: Y'"
Phone: 1-7:10'
E-mail:
This installation is being made on residential or fium 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:
Address: (Q
City:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
FEE SCHEDULE
Number of inspections per item ( )' Qty. Cost Total
" ea. cost
Residential, per unit, service iocluded:
1,000 sq. fl 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: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 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 circuiu: new, alteration, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First brancb circuit (2) 1 $ 55.00 $ S<;).
Each additional brancb circuit 1 $ 6.00 $ In,OO
Miseellaneous fees: service or feeder not included
Each pwnp or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
SignaJ circuit or a limited-energy panel, $ 63.00 $
alteration. or extension (2)
Each additional inspection: (1) $58.00 $
APPLICANT USE
(A) Enter subtotal ofabove fees $ !Q I. OC
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [Al) Sf, ?Jl
(C) Technology Fee (5% of [A]) $ 3,O~
TOTAL fees and sur~h~rg~,(A~hrough C): Q[,3
.. 0
'~~~
ATTENTION: Oregon law requires you to ~
follow rules adopted by the Oregon Utility T~
Notification Center. Those rules are set forth \)"'.
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the ruies by NOTICE: WORK
calling the center. (Note: the telephone THIS PERMIT SHAll EXPIRE IF THE T .
nu~t9flll!tC~gon Utility Notification AUTHORIZED UNDER THIS PERMIT IS NO
Center is 1-800-332-2344). COMMENCED OR IS ABANDONED FOR. . .
ANY 180 DAY PERIOD.
.
.
. . ~.
't:~'{
;'i'
S.P,RINGF.I E.L~.. '..
.~
....~
., ~EGOH
'J"
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.cLspringfield.or.us
permitcenter@ci,springfield.or.us
RECEIPT NO: 20100001] 2
RECORD NO: 811-SPR2010-00110
DATE: 08/23/2010
. ~h '..6.CCOUNtCODE:ij,;:~U.:;,AM6.l.JN:(DUEL ..,,' , ~_,:_:J
'224-00000-426102 $6.00
.. --~-~
. 224-00000-426102 $55.00
821-00000-215004 $7.32
100-00000-425605 $3.05
TOTAL DUE: $71.37
t:rpAYMENTWF'EE;s;''0.,;pAY:ORJ;~ ~ASHi.El'CoBOWLSBYf!J~':c_QMMi;N.i!is'1ft:"';:c,;~. ";'.1,,'::'ti"':',,-.AMOUIIITPAID
Check WlLLAMALANE PARK & REC $71.37
DIST
U[(SCRII:j;TION'o;.v., ,,;. ..,,, .~.'- '1";' \,,"
Branch circuits with service or feeder each circuit
- -
Branch circuits without service or feeder - 1 st circuit
State of Oregon Surcharge (12% of applicable fees) .
Technology fee (5% of permit total)
-.J
83308
'"1"
;~,( ,
~~, J;"'! '"
:>....