HomeMy WebLinkAboutPermit Electrical 2010-9-9
Fiftb Street. Springfield, OR 97477 +PH(541)726-3753+FAX(541)726-3689
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Date:
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This permit is issued under OAR 918-309-0000. Permits are nont~ansferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
,0 Residential -. D Government D Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 1550 so, S1.7..d
City: 5Pf(<-D State: oR ZIP: 97Y 7"6
Reference: Taxlot.:D
DESCRIPTION OF WORK
B~Df/.oOI'YlADI)I7/0N
ZIP: 97 ";17,
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:
CONTRACTOR INSTAllATION
Business name: e" ST S / De El E (,True.
Address: ~~).5'3 80S,C/lG-E IN.
City: 5 P f <..D State: 0 R, ZIP: g 7 q n
Phone: - 7Y/-IY99 Fax: -73{" ';96Q
E-mail: R/Cl(cjloSTSJDEYAHo6.C0I>1
CCBlicenseno.: }lJ'7/0 BCD license no.: 20 -vo)"(
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Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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C\*
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440-2584-1 (9!08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq. fl. or less (4) $134.00 $
Each additional 500 sq. fl. 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 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:
Each branch circuit I $ 6.00 $
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2) , $ 55.00 $ 55.(;(
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 extension (2)
Each additional inspection: (I) $58.00 $
. '- APPLICANT. USE
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(A) Enter subtotal of above fees ~~;r. ()J
(Minimum Permit Fee $58.00)
(8) Enter 12% surcharge (.12 x [A]) $
(C) Technology Fee (5% of [A]) $
TOTAL fees and surcharges (A through C): $ /~-:1 <; VJ
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~OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00266
1558 S 59THST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
pe rmltcenler@ci.springfield.or,us
RECEIPT NO: 2010000287
RECORD NO: 81 I-SPR2010-00266
DATE: 0.9/0.9/20.10.
fDESCRIPifoNI'!.;; '0:~ " 3- Z.:!!~,; .,".~~;~, 'rill!. \ "'!i"(.~";i:~:,tl~~P,~Q.uJfrlc.Q[)~f." ''''. .i ,'.!8MpjJ,NJZR.I.I.I= ", '.' .; -: J
Branch circuits without service or feeder -1st circuiL' 'l-f"''';' I 'i "224-00000-426102 $55,00
Balance of Minimum Electrical Permit Fees .' "., 224,0.0.0.0.0.-42610.2 $3.0.0.
State of Oregon Surcharge (12% of applicable fees) 821-0.0.0.0.0.-2150.0.4 $6.96
Technology fee (5% of permit total) 10.0.-0.0.0.0.0.-42560.5 $2.9o.
TOTAL DUE: $67.86
1'.!F!.A.'yMENr:.iYPE~.'^!I1AYbR~"..CASHIERI$"';~C~AQoI~I::co.M.M~NI$;;; .~-, "';~S?:.:.. ';'S:AMOUNTIF!.A.IDI .....
Credit Card
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EASTSIDE ELECTRIC INC
$67.86
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