HomeMy WebLinkAboutPermit Electrical 2010-9-23
Electrical Permit Application
~CiT& OF SPRINGFIEUn;LbREGON .'~
( .I''-:'>:''\;''t~...",; ~'.."I .': ..... ~_t;~ ..,'r...-:""t'j;,.... '", .
Hi5 Hfth Street. Springfield, OR 97477. PH(541)726-J75J. FAX(541)726-J689.
DEPARTMENT USE ONLY
Sptz,/O - c:J 01'-1-'
Permit no.: .
Date:
9- Z3-/D
Tbis permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days. ' -
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
Job site address:
City:
Reference:
A-
~
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).
ZIP: '! "'ItJ I
Signature:
CONTRACTOR INSTALLATION
Business name: $'1J1:;\,!&JS E~R\c'
Address:f'o SOX k,bp
City: ~Lc+9S.(NSt 11..-1-.. State:cR.. ZIP:974SS"
Phone: 5'f( crt f)..- dz-"'"5o Fax:511-71.f6 -0 't:lg.....
E-mail: -POGL.EGH.RrJ..@i vV\,N'- C(jC'f\
CCB license no.:qs47 C)." BCD license no.:.:90- 373c
Signing supervisor's license no.: '-to crt}- - S
Print name of signing supervisor: Si'E\l9'l G8~
Signature of signing supervisor'
law requires you to
ATTENTION: Oregon b the Oregon Utility
follow rules adoPte~hJse rules are set forth
Notification cen~~1 0 through OAR 952..001-
In OAR 952-001- . co ies of the rules by
0090. You may obtain Nofe: the telephone
calling the center. ( Utility Notification
number for the. or1egBg~_332..2344). \ ~'f\ I \0
CenteflS .. ~t~:~
440..2584-) (9/08/COM) ~.
~
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
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) I $ 81.00 $g(
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 $
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 ofa ser.v.!~~,?~ feeder fee:.
.---
Each branch circuit . /<{,.-: .;1',-". ~f.OO $
b. Fee ~oJ. ~ranch circuits w~ I a ~;u- o.~~~feeder fee:
"...=~ ~.\.. :;,\\c. ?t.~ NIl.'... ~~ ~.~.90; $
~~~r.fl~\li\l-~\)O ,...... ,$."6:00 $ bo
11.;~!~....~Ws~r~eder not il1~iuded
E !it\'l'rnr(lI\l>rWilalitn' circle (2) $ 63.00 $
E~ch sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
. APPLICANT USE
(A) Enter subtotal of above fees $ 11.{/
(Minimnm Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [An $ /h fit
(C) Technology Fee (5% of [An $ 7 OJ
TOTAL fees and surcbarges (A through C): $ /61.(~
.v--.:...
'.
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00147
1262 35TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitCenter@cLspringfield.or.us
RECEIPT NO: 2010000385 RECORD NO: 811-SPR2010-00147 DATE: 09/23/2010
[12!,,_S_CBlP:I!9N::-': -'~;;' ft:'.'.~,c;::"'^:!4Jj"~,' '.' ":-:::-'.:''1'T.0.:''f-=.t';;''''~(::C:():UNT..Cjj'[:lE,:~~'a:,,.4'' ":An"'!i(r~ER.lJ)o':'" "-'- ;" I
Permit Fee AdLustment - Electrical 224-00000-426102 $141,00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $16,92
Technology fee (5% of permit total) 100-00000-425605 $7,05
TOTAL DUE: $164,97
t';ij>A YMENT5T_Yi>E:::i_;-:i>AY.0R:;'r+,&ASHIERfDB6-&E~rrr.I'C(tIlliMEfijLsfi;';J;,;p'"i.~"--" -',-if,": AMOUNT,PAID" . - j
Credit Card
T2394Z
STEVEN R GEISLER
add 1 feeder and 10 circuits to
existing
$164,97
$164,97