HomeMy WebLinkAboutPermit Electrical 2010-9-17
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.E~ectrical Permit Application
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. CITY OF SPRINGFIELD, OREGON .
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225 Fifth Strctt+Springfield, OR 97477+PH(541)726-3753+FAX(S41)726-3689
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Date:
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Permit no .
This permit is issued under 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.
Signature:
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Business name: /)YV"\ I J rf n/1 /){. ~ A 11 .n 1111 A
Address: I~l ~. 0""1i'^- -r~,. , t
City:~no.t;-orrfl State: nQ ZIP:Q7l/1
Phone:AJf -1U1-f ilC::;/ Fax: sJ (. -/0 1-TJ2.L'" First branch circuit (2) $ 55.00
E-mail:-hnLJ..t.;r.(}I(\rla....j1.VlVln.I(.~(..Vi. E~ch additional branch circuit $ 6.00
CCB license no.:( o;:::J.J~D BCD license no.: I Miscellaneous fees: service or feeder flot included
Signing supervisor's license no.: 4L(rJ~1 t:fl Each pump or irrigation circle (2) $ 63.00
Print name of signing supervisor:~8 I 'e'.- c:rn fI (o01.!; oBa;;)1. sign or outline lighting (2) $ 63.00
Signature of signilig supervisor: k.... _11.. ?tJ..."'" - ^" fJ. - Signal circuit or a limited-energy panel, \ $ 63.00
alteration, or extension (2) l
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Zoning approval verified? 0 Yes 0 No
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o Residential I 0 Government . I rslCommercial
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Job site address:( n~ '7-it\ I \ 1J' " --;; T' r' ~ t-
City:~J\...Jr;f\O ~I-t 111 State: 1\ d.' ZIP:q,\.f
Subdivision: \If:I~'2.''t~ Lot no.: Oo.5C
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Name: \ [\1 r"'t.r :\~ -.D .
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1( ~ State: tJlL ZIP:c..t14{Y/
- -' I Fax:
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).
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440-2584-) (9I08/COM)
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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 senices or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
40 I 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 I $
b. Fee for branch circuits without purchase ofa service or feeder fee:
$
$
$
$
$l.J3 ~O
Each additional inspection: (l)
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
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(B) Enter 12% surcharge (.12 x [AJ)
(C) Technology Fee,(5% ?f [A J)
TOTAL fees and'su"~harges (A through C):
$58.00 $
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$lJ.3.CJb
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$'8.\, J
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WNW.ci.springfierd.or.us
TRANSACTION RECEIPT
811-SPR2010-00326
632 SHELLEY ST
CIlY OF SPRINGFIELD
225 Fifth $t
Springfield, OR 974n
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000347
RECORD NO: 811-SPRlOIO-00326
DATE: 09/1712010
224-00000-426102 $63.00
100-00000-425605 $3.15
821-00000-215004 $7.56
TOTAL DUE: $73.71
~ITRfRAYME'N1i~E.hiflTI1jjEAYOR~~~fM.~8JE~Il~~H6~e[R&:~ikti(illco'riijEN1tS!h~.1&_ffit%1lmRL)1U)mih7r~~Ef~2fAM6UNTipAID~~i~~m~;;m~iY;;!~hi
Si9nal circuit(s) or limited-energy panel, alteration, or extension
Technology fee (5% of penmit total)
State of Oregon Surcharge (12% of applicable fees)
Check
40575
OMLlD & SWINNEY FIRE
PROTECTION & SECURITY
157 South 47th Street
Springfield, Oregon 97478
$73.71
$73.71
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