HomeMy WebLinkAboutPermit Electrical 2010-8-25
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Electrical Permit Application SPR'NGFOELD'
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225 Fifth Street+Spdngfield, OR 97477tPH(541)726-3753+FAX(541)726-3689
'. DEPARTMENT USE ONLY
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Pennit no.:
Date: S -z') ~(O
This permit is issued under OAR 918-309-0000. Permils are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
:', '.. "130CAl::GOVERNMENT'AF1F'ROVAL2t";"'':'~'r':~;\'''.
Zoning approval verified? DYes D No
!;,';","(:lcMEGOR:y::.b~?CONS"fRUCTION\\' "'. ,.','
Reference:
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'PROPERTY.OWNER
Name c.\'~ C (:\.'\
Address: :3 9 'f J-
City: 5. ~I~ ~
Phone:
Fax:
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 INSTAllA.TION.
Business name: b/~ -\r.L0c...
Print name of signing supervisor-~
Signature of signing supervis t \,
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ATTENTION: Oregon law requires youto
follow €Ul:rliCadOPt~t:rIJ.'tf~''pca'1 Utility
Notification Center. -m'ose ru,a~ drs"set forth
in OAR 952-001-0010 throu.gh OAR 952-001-
0090. You may obtain copies of the r~les by
calling the center. (Note' the telepnon~
number for the Oregon Utility NotlflG~ ~
Center is 1-800-332-2344). ~ I'
~~<S
440-2584-) (9/08/COM)
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" ..: . _',' . '."... . -_~': . '.1' ":'~"'.' ..r ,:-.,--~.. Cost'" Total
,NurnberQfjn_speCtio:ris:p~r)te;rn,O '_,._: Qty. ~.' -'~~.:~ . " cost
'.' , ..'" " .:"1....__. _' . '(' .,. .~.!,.-'; - ;: .~,;,' ".' l".- . ,:',. ~-;_ .... ...., '.
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: instal/ation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) l $ 95.00 ()(.
$q<;,-
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: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
20 I to 400 amps (2) $ 87.00 $
40 I 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 pan.el
a. Fee for branch circuits with purchase of a service l?r feeder fee:
Each branch circuit {yO $ $'fo ..
6.00 $ "t)...
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 $
Miscellaneous fees: service or feeder I}ot included
Each RPI11P..c:r..jllij?;ation circle (2) $ ,63,00 $
..-. .......... f,.$,,!i~,,q9,
Each ~ig~ ~r B'ttUWtlli,sl1!ieJ?1\(t~ rvnl [ c,r ,,$
Signal\Circuii.or~~:ljr~-ited~~~~~~ p.~~t . ....... 'i$lo3?
alterat-ion,' or\e~tMlsIM {1 \JUC I I MI P~R v1R'~OPJ(
'''L ~'.n..........__ -. .~ __ ....
',.. "", 'VI L"C,C)Lficl1.'d "O"I~IVUI~1 u """ 'ro
Each i~'~liit~oB~' \~~R~c.~~~n,-; l~-),... '$58. 0 $
~~i~z~w}{J:fl}[iJ~~~ARB(ifC1(NT;Jli~fE1:;,tf:7:i~~:U:(~1~;':.lf~ft~, .:.~
(A) Enter subtotal of above fees SIt
(Minimum Permit Fee $58.00) $
(B) Enter 12% surcharge (.12 x [A]) $ (,.;Z It
(C) Technology Fee (5% of [A]) $ 7. < qc
TOTAL fees and surcharges (A through C): $ LflL ob
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00125
3995 MARCOLA RD
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenter@cLspringfield.or.us
RECEIPT NO: 2010000152 RECORD NO: 81 I-SPR20 10-00 125 DATE: 08/26/2010
rDESCRIPtIONt3t~Z:' ;i~;,~---i~~';E,:5' ~?,;;?:~~;;;~'~'~~,<:i~~~;rf~'*t- ~;~~~;1!AC:J~~o.U,NTlc:06E:t~~MO.v~tQQ~~c ~:/:~-,._~~.;.J
Services 201 to 400 amps 224-00..0.~~A26~.o~._~~__._____ $95.00
Branch circuits with service or feeder each circuit \ 224-00000-426102 $360.00
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Signal circuil(s) or limited-energy panel, alleration, or exiension". ;.. ,0224-00000-426102_______ $63.00
State of Oregon Surcharge (12% of applicable fees)' : " . 821-00000-215004 $62.16
Technology fee (5% of permit total) 100-00000-425605 $25.90
TOTAL DUE: $606.06
l::tP.AyMENT;:tyPE-;~;.:;rp)Ji0rf;;;:r;:~WiERo'EiO,~8Yl~7rc:Q~MI;'ijTS";~;:F', ~ .tt'.;~~~:~~;;.AM6UNT;PAID. . 'J "' " ,.J
Credit Ca'rd
096778
robert rogers
$606.06
$606.06
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