HomeMy WebLinkAboutPermit Electrical 2010-9-24
Electrical Permit Application
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225 Fifth Street+Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689
DEPARTMENT USE ONLY
Permit no,: S"IO - 3''13
Date:
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. -
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? ~Yes DNo
CATEGORY OF CONSTRUCTION
I E..Residential _ I D Government I D Commercial
JOB SITE INFORMATION AND lOCATION
Job site address: ::J..7S SO, 70Ul
City: SPfW I State: oK I ZIP: CJ7Y 7lr
Reference: I Taxlot:
DESCRIPTION OF WORK
ADO O\!TU75, (l.E(OGAT(i 5'w17GiI~S
ref( g EDf<.oo/'>1S, EXIT L-r S
PROPERTY OWNER
Name: CIZvtt-C A-z-c/vt.- I) A-
Address: '<:") / u (') l!-c:/':I)/J A-VC:-
City: .,;.p ~L-Il\ I State: cn--I ZIP: ~ 7 Lf "t:
Phone: - - Fax: - -
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( I).
Signature:
CONTRACTOR INSTAllATION
Business name; fASTS/Dc EL ((Ti( Ie
Address: ~~)"S"3 80SC/lH IN.
City: SPHD I State: 0 R. I ZIP: OJ 7 1./ 7?J
Phone: - - 7Lft-ll(Cj9 Fax: - -731:,- Y96Q
E-mail: RIC/(UST5IiJE If' 'r'AH60, (0 /VJ
CCB license no,: I (JTJ 0 BCD license no,: )0 -VOS"C
Signing supervisor's license no.: l./717S
Print name of signing supervisor: 6G. E f( /( Jl-J (j-
Signature of signing supervisor: ) -1JC\ H I~
,
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440-2584-J (9/08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. 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 encrgy (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 $
40 I 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 ofa 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) I $ 55.00 $55,0
Each additional branch circuit 5 $ 6.00 $ 30t.(
Miscellaneous fees: service or feeder not includ~d
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 $
: APPLICANT USE
(A) Enter subtotal of above fees $ 8" s,ot
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $(O~
(C) Technology Fee (5% of [AD $ '1 -u:
TOTAL fees and surcharges (A through C): $ '7 C; '0-.
w.NW .ci .springfield. or. us
TRANSACTION RECEIPT
811-SPR2010-00373
275 S 70TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000394 RECORD NO: 811-SPR2010-00373 DATE: 09/24/2010
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Branch circuits without service or feeder -1st circuit 224-00000-426102 $55.00
Branch circuits without service or feeder - each additional 224-00000-426102 $30.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $10.20
Technology fee (5% of permit total) 100-00000-425605 $4.25
TOTAL DUE: $99.45
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Credit Card
02565c
EASTSIDE ELECTRIC INC
$99.45
$99.45
.