HomeMy WebLinkAboutPermit Electrical 2010-9-13
ElectriCal Permit Application
I
225 Fifth Street. Springfield, OR 97477+PH(54J)726-J75J. FAX(S4I)726-J689
...,
'. 'bE~tRTM.ENT USE ON.L Y
Pennit no.: 5,( 0 .00 zas
Date: 9~/3 . ( 0
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.
," ";UOCjl.LiGO\lERNMENT .:AP.~ROVAlEft?:\;i:fi'!')?i:'R'j::
Zoning approval verified? DYes D No
,!i<',ft..>i,:'cMEGORv:KOF:;CONST:RUCTlONY<;!;\
D Residential D Government rzl,Commercial
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City: S ZIPC? 7 'f 77
7 3ZOZZ-C Taxlot:OI,OO
. : .DESCRll'tION;OF..w()RK'.,i:..:,:\.:,;,:.hY;;f;....~
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Name:
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).
ZIP:
Signature:
City:
Phone:S"}- .
E-mail:
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
laW requires you to
ATTENTION: Oregon b the Oregon Utility .
folloW rules adoPte~h:Se rules are set lorth
Notilication Center. rough OAR 952-001-
In OAR 95, 2-001-0~{~~hcoPies otthe rules by 1\(\. .f'\
0090. 'fou may 0 al Note: the telephone \y tJ>..':\-I
calling the center. (on Utility Notilicatlon ~.
number lor the. or1~~00_332-2344).
Center IS ~ ~
440.2584-J (9/08/COM) \y '
2:~V.::;,1*~~'}~~~:fiq~,th\::f;~mi7:iI;E'E~S'CH EJj.QeE~9~'1t~~~t1ft~~1:~~?$'~~~}t~3
'. . :'.', ',',.'. ....:0.,.": :' '" .. Cost, I' 'Total'
,'.N~~~"~-~;.?,f,!,'~!~~5!~?,:r!;,-.H~t:!~~~,~;:~\' ,g.:q~~. .>,:4~a~~, ," \~. cost ,',
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) I ! $ 32.00 $
Each manufactured home or modular $ 53.00 $
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 ser~ices 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 orfJeder~.s~~tfon~~J)Qve
BrancG!c'i}IJ;\8~w.!;it"'f'A'f'I em\WiP~fpllilf. VV~~~
a. Fee for:~r~n ~ /ils ~ltn.o....hjtl'\\<8' <P-li:R-l'I\l br~;;~W fee
Each/~}iric~:f.~W'-;r\ nR IS ABA~DU"t:$1 ~'60" ,$
b. Fee f6t~io/i~ikrir\'\'~r'f~Vt-l0>\lr.chase of aseivice or feeder fee
First b~~~ch circuit (2) $ 55.00 $
\ 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 $63
alteration, Or extension (2)
Each additional inspection: (1) $58.00 $
f~JgE~\~i~:j;zrJ@j~WifN~{ftt~;ARei1'1ci\Nt{XUS'E*i.,i~~..;~~~g:~f,fitt:t)~'~fY:;
(A) Enter subtotal of above fees
(Minimum Permit Fe. $58.00)
(B) Enter 12% surcharge (.12 x [All
(C) Technology Fee (5% of [All
TOTAL fees and surcharges (A through C):
$ b 1
$7S(,
$ ) II
$7~~
W'NW. ci. springfield, or, u s
TRANSACTION RECEIPT
811-SPR2010-00283
'.;--.., -l .
3318 GATEWAY ST
CITY OF SPRINGFIELD
225 Fifth $1
Springfield, OR 97477
541"726~3753
permilce nler@ci,springfield.or.us
RECEIPT NO: 20 I 0000304
RECORD NO: 8 I I -SPR20 I 0-00283
DATE: 09/13/2010
[p~~CRIP-TlbN'~,",1'~';'~i' ,_-~ry5::"-';i-~F:, ;p't;0~*C:;';:~",'ii:,,:' i-ii:;_C:O.UN:(C_OQE::+:"';%l?':',,~ :'~[\II9J-!NLl2.UJ::- 'I
Signal circuit(s) or limited-energy panel, alteration, or extension 224-00000~426102 $63.00
Technol09Y fee (5% of permit total) 100-00000-425605 $3.15
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $7.56
TOTAL DUE: $73,71
I' PAYMENUYP.E,:j::"'\BAYOR:~:,'g~s8.iER::DBol'Vl.sl3i~;;"CQM[\IIf:'t:!IS1f::S:;;-:'.':;'::,';' :.:,";'-:0, . A"'10UNTPAID
Credit Card
213162
GLOBAL SECURITY &
COMMUNICATION INC
"
$73,71
$73.71
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