HomeMy WebLinkAboutPermit Electrical 2010-8-23
Electrical Permit Application
.
225 Fifth Street>Springfield, OR 97477+PH(541)726-3753>FAX(541)726-3689
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DEPARTMENT USE ONLY
~4..10 .Ot::) t I Lj
Penn1l no.:
Date: g"" ~,2.3 ~ 10
This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for] 80 days.
LOCAL: GOVERNMENT APPROVAL"
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
Residential
PROPERTY OWNER
f'
th l\ILJ
State: 0 ~
Fax:
Name: -r.
Address:
City:
Phone:~/-7W
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:
Address:
City: c..,
Phone:5iI-
E-mail: C,,_
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
ZIP:cn~d!
\0
\0.
Signature of signing supervisor:
o on law reqUires
ATfENTION: reg d b the Oregon Utility
folloW rules adopte Yse rules are set lp~tUr,
Notification cente~i b~~rough OAR 952../501,
in OAR 952-001-Obt in copies of the rules by
0090. You may 0 a Note'. the telephone
calling the center. ( n Utility !\IOli\iCa~:9r.
number for the ori~~gO_332-2344), ~
Center IS .~
~
440-2584-J (9/08/COM)
:.. ....;:i...,;<.;:'':..'.FEE..SCHEDUlE:..;. ...'.....,':' "., '. ,",
Cost
Qty. ea.
Nu~ber' of inspectio~s per .item. ()
Total
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) $ 81.00 $
201 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 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;
Fir~\ 6.};r~ Stellit (2) . r'" $"'55:00 $ S S-
Ea~~~ddiR<ITIilMllfl8HIMJitEXPIR :~UH' ~$ f-
Miscen.MiI~l,Pr~l:iIJ~i~ei Ii) IWI
E h\<!.u.vll\lIr.r~;\I.t;U.lln_.~ H' 1"- u"" '>!.'.' $
ac p~~,P ...o!:,,,!rnRa^l~~n""tlr'clr. '. I 0.:1.00
,.."" r U.~.~r\'_L'-''',' .
Each sign or outlme ligHting ( ) $ 63.00 $
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (1)
'. ':;:".';,,;:;X;:. .~!i,.ri'A'PPl"ICAN' 'T, 'U" SE' .
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$ 63.00 $
$58.00 $
." .."..........
(A) Enter subtotal of above fees
(Minimum Permit Fee $58-00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through C):
$ b (
$ 77Z
$,?Or-
$ -7/"
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-'---OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
permitcenter@ci.springfield.or.us
l:;e.AYMEN;HYREii-:!PAYOR";"f,'cASHif~:,DB_o",CsEiY~.CPMMEtfJ:S
Credil Card RITE ELECTRIC INC
RECEIPT NO: 2010000115 RECORD NO:811-SI~'R2010-00114. DATE: 08/23/2010
li:>ESC~eJION:5"" ~. :;;;,,:.:;,;,~,;.;J~;:'";f/.~i170i~A'CCO:UNT3;;QbE~tf::J~MD_UNtD_lJE"...": .' 'if; ,'U
Branch circuits with service or feeder each circuit.:t . .: 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
::,$1i;:'ivp:,~:';",;)~';kt"': AMOUNT- PAID
$71.37
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321465
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