HomeMy WebLinkAboutPermit Electrical 2010-8-23
Electrical Permit Application
9 D
225 Fifth Street. Springfield, OR 97477.PH(541)726-375H FAX(54 1)726-3689
~PRINGFIELD Ui',.';.'.i"""'"p;
~i~~Z~'~1~
DEPARTMENT USE ONLY
SPt2.IO C> C 1\3
Penn it no.:
Date: ~. 2.7-/0
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 Ves 0 No
CATEGORY OF :CONSTRUCTION .
.Residential 0 Government 0 Commercial
,r'y./JOB ,SITE' INFORMATION;ANDlOCATION~.'.;,"':::
Job site address: _ "/.
City.
Reference:
&.:l
Address:
City: . y\
Phone: :SlIf-
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).
ZIP:t;-"{l~
Signature:
CONTRACTOR INSTALLATION
-:t:
City:
Phone:!>>I-
E-mail: C,,_
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
, \0.
on law requires you to
ATTENTION: Oreg d b the Oregon Utility ~ '>\'
follow rules adopte y rules are set forth if
Notification cent~~1~~~:~U9h OAR 952-001~
in OAR 952-001- , 0 ies of the rules b rf\
0090. You may obtain c oie: the telephone ~~~
calling the center. (N n Utility Notification (\ ~Il\.
number for the or1e8g000.332-2344). I,A,~
Center IS .
\r
440.2584.J (9/08/COM)
.,'.::. ".'i'<': ,ii, FEE SCHEDULE- ..,.
Number' of inspectio~s per ite.m. () Qty.
Residential, per unit, service included:
". :.' '.;C'.' 'i."';.:
Cost Total
ea. . cost
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2)
20110400 amps (2)
40 I to 600 amps (2)
601 to J,OOO amps (2)
Over 1,000 amps or volts (2)
Reconnect only (2)
$ 81.00 $
$ 95.00 $
$158.00 $
$205.00 $
$469.00 $
$ 63.00 $
Temporary services or feeders: instal/ation, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
40 I to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alferation. extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit S 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
I $ 55.00 $ 5f
( ~,.'~'O~, ,..$ r?
Miscellan~l'!'~~~ES!'rvice or feeder not ir"l(J \l1 aRK
Each pumRPMsrig~R>h'ldJc '. ~,,~ ';k)$,"'-H>QS 001 .'
Each sign or,builih\ftllillMj\~ ,;' ^ ,> \~eIHQ) [d
Signal circGit\~'r~~VUrr\it~#eX6~anel,- $ 63.00 $
alleration, '2f1,,~te~g<in~W t'ct\IUU.
Each additional inspection: (1)
,;.L,','Z0';;::..';:o::.:iii,'ApPl.ICANT. USE' .
$58.00
$
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter ]2% surcharge (.12 x [A])
(e) Technology Fee (5% of [A])
TOTAL fees and surcharges (A through C):
$ b(
$ '77Z
$ "Jor
$ //17
....
..,;.f-....
':.){:>.;
',j,>
-....::.~j
::; ,~;~~ I
.' ~i',," ,
._' ~,u,i;
'~',) Fe . ~"( . ~~.
i'l
CITY OF SPRINGFIELD
225 Fifth Sl
Springfield,OR 97477
541-726-3753
TRANSACTION RECEIPT
www.ci.springfield.or.u$
permilcenter@ci.springfield . or, us
RECEIPT NO: 2010000116 RECORD NO: 81 I-SPR2010-001 13 DATE: 08/23/2010
1.Q.!'.$C:RJPTI9N~:~l:<;',.:::""; b'::'''\ -". >,; ,,;;;};;, . '~'" .. ACC9UNT~C.ODE',:\ ., ~~MO:UN:U)_UE~j.:....._~J
Branch circuits with service or feeder each circuit 224-00000-426102 $6.00
Branch circuits without service or feeder - 1st circuit '" : ' ...". '224-00000-426102 $55.00
,,\:;,. ;.
State of Oregon Surcharge (12% of applicable fees), 821-00000-215004 $7.32
Technology fee (5% of permit total) 100-00000-425605 $3.05
TOTAL DUE: $71,37
F,~pAYMENT TYPE#'''s''~PAYOR:;;;;~c~siflEii'b'B6WLSBy;;'f';'.CQMMENI.S,;;y',il;;~~;'k-'., .-- :'AMOUNFPAID -.; ';;;', ..1
Credit Card RITE ELECTRIC INC $71,37
321465
..~,,'.~-"
,
,.;;;.......;,.
~";\'" ."t .
, :", ~-~
,,;,'.,-:.
":.,,,':
....u._.__.,,.
I.'.
'!.l
','
,
"
'J!
A
.,
:', ril'J
: :~
......; .
,;r
;~:c.~'"
:~::~
'-i>'-'
1'..J
'-5Fi-:;--
,,+_U-.~':. .
,
:\
'; ~ :
'. "~'
"4.
. "
~
;;0
, ',~,,_.'I-