HomeMy WebLinkAboutPermit Electrical 2010-8-31
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Electrical Permit Application
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225 Fifth Street.Spdngfield, OR 97477+PH(541)726-375HFAX(541)726-3689
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DEPARTMENT USE ONLY
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Permit no.:
Date: .8. 3./-/D
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, .
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Zoning approval verified? [J Yes D No
i;i,"CATEGORY,~Y0f,;'C0NSTRUC::TION\~i> .
o Residential 0 Government ~mercial
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City: ~ State: Otl... ZIP: G11-1 7
Taxlot.
DESCRIPTION OF'WORK'
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PROPERTY . OWNER .
Name: ,w..t,'c..- Z>~_i'-D..t..-
Address: 'te 7 S-I j)/.:..,,; <- (Ld/J
City: l.'~" o. L- ZIP: 'i1-{c'J,
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This installation is being made on residential or farm property
owned by me or a member of my immediate fam' ,This
property is not intended for sale, exchange, Ie or rent. OAR
479.540(1) and 47 0(1).
Signature:
LLATION'
Business name: flD~ v.(
Address:
Print name of signing supervisor:
Signature of signing supervisor:
'~~Y'~-:~J~~~~~W~:I~~1,f7,+\--FEE~SCHEDOUiE:.1t~Jt,~~~!4rif;~~~~~F1
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. ),~ u ~.~e,r' 9l'.i~_~p~~tl~~'~~ ':~~r j;~.~: (,)':<.;~:IQ~Y'.' " Cost ;, . Total'
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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 $
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 paner
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 $
b. fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) t $ 55.00 $5'>
Each additional branch circuit 2-" $ 6.00 $I'L~
Miscellaneous fees: service or feeder ':lot 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 extension (2)
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $ l7 S-
&iii Enter 12% surcharge (.12 ~lAir .. $ zi
f(Thfilt{ 5V,t;,tr~j)~t,~v~~~ $ L'IS'
imll~ .~g'~{\l.e~(~J:~f~~g~ C): $ '211'1 :"If''
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ATTENTION: Oregon law requires you '.0 '"
follow ruhis adopted by '.he Oregon Utility @'
Notification Center. Those rules are se'. for'.h NOTIG
in OAR 952-001-0010 '.hrough OAR 952-001- THIS P
0090. You may obtain copies of'.he rules by AUTHO
calling the center. (Note: the telephone
number for the Oregon Utility Notification COMM
Center is 1-800-332-2344). ANY 180 DAY PERIOD.
440-2584-J (9/08/COM)
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www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00189
632 SHELLEY ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541~726.3753
pennitcenter@ci.springfield.or.us
RECEIPT NO: 20 I 0000 192
RECORD NO: 811-SPR2010-00189
DATE: 08/31/2010
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Branch circuits with service or feeder each circuit . . " 1.~, ~:''' ~ 224-00000A26102 $120.00
Branch circuits without service or feeder - 1st circuit ... ,"', t. i. 224-00000-426102 $55.00
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821-00000-215004 $21.00
100-00000-425605 $8.75
TOTAL DUE: $204.75
1"'PAYMENt fYPE~Y;';'PAY0R;~?CAsHTER"DBoWCSBY0i.~',cdnirMENtS:!ii''ifflJiiJiii..fl.i/':' /-:~AM6uNT PAlOI';j[,:'Ii>.'Y"" I
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State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permillotal)
Credit Card
093131
. mason menge
$204.75
$204.75
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