HomeMy WebLinkAboutPermit Electrical 2010-8-23
225 Fifth Street. Springfield, OR 97477.PH(541)726-3753+FAX(541)726-3689
SPRINGFIELD 14l,~;.''''-)I;"'t'
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DEPARTMENT USE ONLY
SPi2.IO '00 I' z..
PermIt no.:
Date: :f;' Z-::r -/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
o Government
City:
Reference:
Name:
City.
ZIP: c..""","'"\
Phone::>41
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).
Signature:
CONTRACTOR INSTALLATION
Business name: ~
-:t:
Address:
City: c..,
Phone',5-iI-
E-mail: c:..._
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
\0.
Signature of si ning supervisor:
. regon aw reqUIres yo 0
foUow r~les adopled by the Oregon Utility
Nollflcatlon Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
caUing the center, (Note: the telephone
number for the Oregon Utility Notiflcatio\nC".'(] /
Center is 1-800-332-2344). ~ l~
tw
440-2584-J (9/08/COM)
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., .i...........FEE SCHEDULE.' ~,'
'. '.-1''''-';'- '.' ....'
Number' of inspections per item O. . Qty. Cost Total
. ' . ,'.1 ea. - cost
Residential, per unit, service included:
1,000 sq. ft. 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) z... $ 81.00 $/bZ
201 to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
60 I 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: instal/ation, alteration, relocation
200 amps or less (2) $ 63.00 $
20 I 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 circuits: 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 branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
M'iQTiI.Gmu,s fees: service or feeder not'incIUclea'
iLl<i/,.'j,J'n~RMfTigSlib\\klr~~jRE IF THE fWOO!60 $
lNliJ tllm~o~ ilt; t'l:HMJf .00 $
~fill~if~i~ t - ~:u t J~ 6300 $
te tih\l, d:biIMrJ?m/ili~D. . '. . .
Each additional inspection: (I) $58.00 $
:-:-;k.;',:('S;L~j;:;';'iApPLlCANT 'USE. .,
(A) Enter subtotal of above fees $ 1hZ
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AJ) $ I 7' <1<(
(C) Technology Fee (5% of [AD $ 8'0
TOTAL fees and surcharges (A through C): $ /'0 ,S ~
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00~ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541.726.3753
www.ci.springfield.or.u$
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permi1center@ci.springfield.or.us
RECEIPT NO: 201000011 7
RECORD Nq;8'h-sPR20\?-00112
DATE: 0812312010
[liESCBI~T19~;. '.. ~:. ",.Ji: -J:;;,' .J:;;'jjj'~J:&f "c,',,',: .:ft.-CCb.UN'(C.OQE,;' "':~~;;;' .'~_ivIQU~'LD,UE....J:""" "',1
Services 200 amps or less 224-00000-426102 $162.00
Technology fee (5% of permit total) 1 00-00000-425605 $8.10
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $19.44
TOTAL DUE: $189.54
~::PAYivlENtj;YPE' "':i~AtOB::"c"CASHIER::DElbWLSBY";;': .CJjMM~:'N:tS~'.i.t2i::i:::'::'.:" . AMOUNT pAID' v.
Credit Card RITE ELECTRIC INC $189.54
321465
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