HomeMy WebLinkAboutPermit Electrical 2010-9-27
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Electrical Permit Ap lication
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225 Fifth Street. Springfield, OR 97477.PH(54I)726-3753+FAX(541)726-3689
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Date: .
7:7--/0
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if wnrk is not started within 180
days of issuance or if work is suspended for 180 days.
..', . ,LOCAL. GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
esidential D Government d Commercial
':JOB. SITE INFORMATION AND . LOCATIONi
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City:
Refe
Name:
Address:
City:
Phon
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).
S-i-
ZIP:
Signature:
City:
Phone:
E-mail:
CCB license no.:, '"
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-J (9/08/COM)
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FEE.SCHEDULE ,-
"-" .',' ,. Qt}:. Cost Total
Num~erof inspections per ite~ 0 > ea~ cost "."
. ,
Residential, per unit, service included:
1.000 sq. fl. 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)
Senrices or feeders: instal/a/ion, a/Jeration, relocation
200 amps or less (2) $ 61.00 $
20 I to 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $156.00 $
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: instaJ/ation, alteration, relocation
200 amps or iess (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 of a service or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) / $ 55.00 $SS'
Each additional branch circuit -, $ 6.00 $("'..-....,,
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or eX1ension (2)
Each additional inspection: (I) $58.00 $
:';1~ -'~ ;_~"~~;>:"_~~:. :. . APPLICANT',USE .' .
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(A) Enter subtotal of above fees $ hI. oC
(Minimum Permit Fee S58.00)
(B) Enter 12% surcharge (.12 x [A]) $
(C) Technology Fee (5% of [A]) $
TOTAL fees aod surcharges-(A through C): $ 7/.3
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~OREGO~
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00109
510 S 5TH ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000167
RECORD NO: &11-SPR20IO-00I09
r PAYMENT TYPE,
PAYOR' CASHIER; NMACHADQ 'CQMME"'IS '
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DATE: 0812712010
~]IIlQU"'H)_UE
$55,00
$6,00
$7,32
$3,05
$71.37
AMOUNT PAID
IDESCRIPTION,' '"
Branch circuits without service or feeder - 1 st circuit
Branch circuits without service or feeder - each additional
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of pennil lotal)
~~_C_d9N:tC_Of)E~~' 'ii'
224-00000-426102
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
Check
4360
, GMD ELECTRIC
$71.37
$71.37