HomeMy WebLinkAboutPermit Electrical 2010-8-24
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Erectrical Permit Application
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225 Fifth Street. Springfield, OR 97477 +PH(541)726-375H FAX(54 1)726-3689
DEF'ARTMENT USE ONLY.
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Permtt no.:
Date: ~ Z ~-(O
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. .
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-001-0010 through OAR 952-001- (A) Enter subtotal of above fees
0090. You may obtain copies of the rules by (Minimum Permit Fee $58.00)
calling the center. (Note: the telephone (B) Enter 12% surcharge (.12 x [A])
number for the Oregon Utility Notification ~
Center is 1-800-332-2344). ~ (C) Technology Fee (5% of[A])
\Sj t>< ~ TOTAL fees and surcharges (A through C):
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Zoning approval verified? 0 Yes 0 No
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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 n AR
479.540(1) a d 47, I),
Signature:
: CONTRACTOR INSTALLATION.
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Business name:
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Address:
City:
Phone:
E-mail:
CCB license no,:
Signing supervisqr'
Print name of sign ing supervisor:
Signature of signing supervisor:
/
ZIP:
440-2584-) (9/08/COM)
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i'Nu~ber ofJn~p.e~tio'ris p~!"jt~m~O,;,.;~, Qty.
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Residential, per unitl service included:
. ,Total
'-' cost
,1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134,00 $
$ 25.00 $
$ 32,00 $
$ 63,00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81,00 $6
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)
20 I to 400 amps (2)
401 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;
Eat;h branch circuit
$
b, fee for branch circuits without purchase of a service or feeder fee;
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $ I
Miscellaneous fees: service or feeder ':lot included
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$' 63,00
Each P~,rnp,o/I.r-rtg",tion circle (2)
Each signM~r~o Iwri!\ll-JJQ.L EXP RE 1
Signal c,i[.sui\c?[).p!!W@!l!l~~rmljla;rdi\1
alteratH{Ih.9,f 1~.r:.ly'1~,A )
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Each additionaLinspee ' 1100
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
www.d.springfield.or.us
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permitcenter@ci.springfield.or,us
Permit Fee Adjustment - State Surcharge
Permit Fee Adjustment ~ Tech Fee
RECORD NO: COM20 1 0-00833 DATE: 08/24/2010
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224-00000-426102 $81.00
-,_._-------~._._.~-
224-00000-426102 $18,00
---,---
821-00000-215004 $11,88
100-00000-425605 $4.95
TOTAL DUE: $115,83
" "~PAV5R'",CASHiEii:iDi36WLSi~J;~CQMMi~'iiiish;Ii;:"A<'{.:<7 ;";;il,,;;t;i,+:AMOUNT 'PAID'
verne baarstad " _.~>i~t ';"l"~^~~;., $115.83
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RECEIPT NO: 2010000127
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Services 200 ame.,:; or less
Branch circuits with service or feeder each circuit
~ifAYMENT T.VeE"
Credit Card
61426b
$115,83
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