HomeMy WebLinkAboutPermit Electrical 2010-8-26
Ele'ctrical Permit Application
-
225 Fifth Street. Springfield, OR 97477+PH(541)726-J75JHAX(541)726-J689
, .
DE-F>ARTMENTUSE ONLY
. . '^~"';,,' . " .
~(O-OO I Z
Dale:
r,..z(; .(0
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.
. " ';COCAL:G0VERNMENTAP'I'.BOV A,"~ye;~r;i'T".
Zoning approval verified? 0 Ves '0 No
;:, ,):,,(;. S,{CATEGORYiJ(jF.;'CONSTRUCTION~~" ,
o Residential 0 Governmenl 0 Commercial
~~~'~tOB_~SITE~:INJ;(jR.M,lI;TION!;AND~CClCAtl()N'\'l~'!j'i~~F
Job site address: 'i~;,h,<,-.<.-'<-
City: De- ZIP:
Q. \ Taxlo!.:'
:. 'DESCRIPTION: OF' WClRK'.";'
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:
Business name: 'S....,(\
Address:
Signing supervisor's license no.:
Print name of signing supervis
,Signature of signing supervisoL
ATTENTION: Oregon law requires you to M ~
foUow rules adopted by the Oregon Utility \))~~).):
!'Iotlflcatlon Center. Those rules are set forth ".V
In OAR 952-001-0010 through OAR 952-001- 'V'
0090.. You may obtain copies of the rules by
calling the center. (Note: the telephone . .;-..
number for the Oregon Utility Notification \j"'"
Center is 1-800-332-2344).
440-2584-J (9/08/COM)
\~~'j~~;11~~f!~A;~~r.~~fr0i,~~9f;,~ fEE,~lS'C H t:'D):JtiE-~~;i0~!ji?~;);i~1~~lttit~~~~1~
- .-:......-. .' >\-~-' ,...' + ~.. .-",. , CosC:. . Total
J.~u~~er ~()n~pe~iIo~#'p_~:~.i,t~,in;'(.)1t~;~.' 'Qty.
" _ ,. ~1' '. _ .'..' .. ,.~~.-,.-,.-,_, '.," ", '.l '._ 1.,_; .... ..-, ''-' .-j:~::l~:'" , .cosL '.
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 $RI -
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:
I(V Each branch circuit L( I $ 6.00 I $,.) Lj-
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 I $
Each additional branch circuit "$'jj~
Miscelll~~ 6~~ service .or /f~d"f'{(f~Y,i;8 ~J::': lCo 01
Each PU~l1l%ifl\S~~ atB-1H S Pt'n:l~f $
Each siglJl,~'W~ Illiir IS I\B S-lU' "$ 63.00 $
Signal cirtW\l&MriJ!fif~q~"f'i_~' $ 63.00 $
alteration,-R{\R't<\~0ril
Each additional inspection: (I) $58.00 $
:fZ~~~~jfffi2frt~~f~l~~;~'~~~Rei2ICANT~~)JSEj~b:_:1'fk~~~;~iN5!:)~t;~1i:~;:.;)
(A) Enter subtotal of above fees $ /0<
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ 1'L 6
(C) Technology Fee (5% of [AD $ 5'Z
TOTAL fees and surcharges (A tbrough C): $ 117
.
1./
o
s~
-
..
S~~~NG;EL~,
~.
~;O'RfGON
www.cLspringfietd.or.us
TRANSACJION RECEIPT
811-SPR'261'b~'00162
. "-'~."'" . -, "
16'7:3,' ~F'ST
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield,OR 97477
541-726-3753
permitce nter@ci.springfield.or.us
IlECEIPTNO: 2010000153
IlECOIlD NO: 81 I-SPIl20JO-00162
DATE: 08/26/2010
[0- ES' CRIP"T'ION"'" ~",,,,.,,,,, ",."~,3;",m"""-~"'-f"""~' "
I~ - ;' ,,,SiY?;';;',,-,-. ,~,'''~''':r'?''r;~*;;$:':::,'''~ :~,;;;:r~,,","':~'^
Services 200 amps or less
Branch circuits with service or feeder each circuit
State of Oregon Surcharge (12% of applicable fees)
TechnologY fee (5% of permit total)
~~~~'V'~C.C_6@T~C:QREFi?q',.,I-;~;~:iMQl)~,ft~QlJE .~ ;7"'. ;;' ,- ;1
224-00000-426102 $81,00
224-00000-426102 $24.00
-------~-
821-00000-215004 $12,60
100-00000-425605 $5,25
TOTAL DUE: $122.85
.-rP'AYOR<'.:::;g;A:sHrER:~DB:OWi1SBY';'f;r:'c'6MMEI.jTStl'''';p:.,~",~';;;: Y'{i~.'rii-"':":;AMOUNTP AID .' ,; cc' -!
. _ _~ ;,. . '. .. _.".__-.-.,_--:_~._.~__._1.4.t4 . - .~...__.____.._~.___.~__.;J
[:'!PAYMENT,T.VPE,r;..
Credit Card
013626
. roberf rogers
$122.85
$122.85
~.-':."1.~
".,
, P'lc)',, ~\h {;ie'I"',.
I '~!:I\:,~j'- ':-! d.\,.:I . '-,
'~Yl:3'i ;~ ~.~ \
I....'
"
"\i,
f:"~'}~.:f (/,y~<~,.:.(..
I'"
",,'
.~ 'l~~;l