HomeMy WebLinkAboutPermit Electrical 2010-8-25
Electrical Permit Application
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225 Fiftb Street. Springfield, OR 97477+PH(541)726-3753HAX(541)726-3689
SPAINGFllf!LD
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DEPARTMENT USE ONLY
S~4210 .00/'1
Permit no.:
Date:
8~?.s-IO
This permit is issued uuder 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? DYes D No
CATEGORY OF CONSTRUCTION
esidential
Reference:
Name:
Address:
City:
Phone:
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: S1E\,a,~ "E-~R\C
Address:fO BoX hb?
City: fLc4lS.iNJI II.L State:c:R ZIP:9 7Lf-~S
Phone: 5W '?tf)..-;).I':Xi"O Fax:31/- 7<f6-0'!;/ 0l-
E-mail: .f'OGLEGH RrJ €E) vV\SN f Cd Vi'
CCB license no.:Cf~:A7 CJ, BCD licenseno.:.:90- 3T.3C
Signing supervisor's license no.: 'fo q4 - S
Print name of signing supervisor: sTE~'EN G 13~
Signature of signing supervisor:
ATTENTION: Oregon law requires youto
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-001 0 through OAR 952-001-
0090. You may obtain copies of the rules by ~
calling the center. (Note: the telephone "
number for the Oregon Utility NotificatIOn i\ (\, .\. 'v
Center is 1-800-332-2344). V{~~(J.J
440-2584-1 (9108/COM) \'\~
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq. ft. orless (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)
201 to 400 amps (2)
401 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; 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)
Each additional branch circuit
I $ 55.00 $ sS"
2 $ 6.00 $'2
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal cirtJin.;fMli!>>lt~~:energy paoel, $ ~~~~,\, '$
aIteratloo"o.!i~te.'J81on"".. <:U^' t t:' DtR li:i:i~j:, ,nQI(
Each addi!i~~~\',i' . ~ T HR ~ FRMPJD9c ~OT .:
r.nMMI=~1 .~,~ ilSE1nhll=n FOR ..' .::'
(A) Ente(siMo$Btffl>,q,e"'~flJOD'$ /7'"
(Minimum Permit Fee $58.00) C>
$ S Q'1
$ 33~
$.., ~J'
,
(B) Enter 12% surcharge (.12 x [A])
(e) Technology Fee (5% of[A])
TOTAL fees and surcharges (A through C):
. . .
Slr.~.EL~
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~O.REGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00146
2540 0 ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
permilcenter@ci.springfield.OLUS
RECEIPT NO: 2010000150
RECORD Nil, 811-SPR2010'00146
DATE: 08/26/2010
!OESCRllfiIONT'-j":;.:: .;.;4":;'~jJ=-1'4,jj~~' ~;:':~~:~,,*,".'7!,"j:::~ci:.QU~jlG:Qi:lE;'i,;'i;,;';t',: .~MQl)t:ftJ!UI:~j .,. 'r'.,,;1
Branch circuits with service orfeeder each circuil 224-00000-426102 $12.00
Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 ____ $8.04
Technology fee (5% of permit total) 100-00000-425605 $3.35
TOTAL DUE: $78.39
~PAYMENr;;t-YP.E'~-:eA'yOR~CAi;HIER'QB9)M'~B~-\;;iffQf11ME.f:!'[S:~f:l\~4;~.' ~:;'!-~i:1Ethie.J~_Q.\!JH;f,~:I!)..Q:-!-,.'.. . ."....1
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Credit Card
474917
STEVEN R GEISLER
$78.39
$78.39
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