HomeMy WebLinkAboutPermit Electrical 2010-9-1
225 Fifth Stre".Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
, DEPARTMENT USE ONLY
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5?t'ZZOI~.bO 1
Penn it no.:
Date:
-I-Ie)
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? 0 Yes 0 No
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Name:
Address:
City: .5:
Phone: y
E-mail:
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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 479.590(1).
Signature:
LATION
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
ZIP:
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- .
0090, You may obtain copies of the rules bYM .
calling the center. (Note: the telephorCfrll .
number for the Oregon Utility Notificati~ ~~f)\(Y
Center is 1-800-332-2344). ~~
440-2584-J (9/08/COM) ~
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.,,' "", . \,.:.....,": ',"-'''.' '....~'., ;",- "~':. .. Co,l . 'Total" ,
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, ,,,..,.~ ...' ....c... ...._.' .0,' ..",.)1'\. .... ", ,\..." .,. "}"-~'" ,"_' .l_{":~~~\ .. 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) $ 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 $13 (
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 panel
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) $ 55.00 $
Each WiitTJQliihnch circuit . if~'6jio~ " $
M~"oI.I<ll"V<llME ~,_. ,'"' ."M
Each pu ~~. 1 . CI TIIl~-ft~~ ilSl.
. '1,;: I:~II\-ril' . 6~.~ . $
Each 51 ~ e ,,~~,6 . ", .'.
Signal.cireuit orVali~ited~energy pa~el, $' ~3 ~o $
alteration, or extensIOn (2) .
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees I
(Minimum Permit Fee $58.00) $ 8
(B) Enter 12% surcharge (.12 x [A]) $ '1 n
(C) Technology Fee (5% of [A]) $ lfOf
TOTAL fees and surcharges (A through C): $ If" ?
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~'ORI!GON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00197
2780 NOVA ST
CITY OF SPRINGfiELD
225 Fifth 51
Springfleld,OR 97477
541-726-3753
permitcenter@ci.springfield,or,us
RECEIPT NO: 2010000205 RECORD NO: 811-SPR201O-00197 DATE: 09101/2010
FOESCRII?TION:> ,,{.:';;\>i;lf;~ ]\~;;~~~i:!l';i~~1IJ1'1.'f):;~::[~j'1iflt;"i~'A~Q@1rb.C.Q~0'~,:1;;.'1,!';i'1:1~;;.J:~M~JI1.~II",DV,E>[".:'" ".
Services 200 amps or less 224-00000-426102 $81.00
Technol09Y fee (5% of permit total) 100-00000-425605 $4.05
State of Oregon,Surcharge (12% of applicable fees) 821-00000-215004 $9.72
v .' TOTAL DUE: $94.77
Ui\.V,MENT TJ.Bg'.S:;;!;'P.A'YORt'EcASHIER:'6]'o~sil'(~~d'f~lMEiIi:f.s'-',':Ji.jc;;,;:;.;r':"';t'0t.1l'~~AMQ.UNTP.~jQ : . -} .,
Check
156
ECKERSON CHARLES R &
SUZANNE M
$94.77
$94.77
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