HomeMy WebLinkAboutPermit Electrical 2010-8-19
Elec.trical Permit Application
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225 Fifth Street. Springfield. OR 97477. PH(S41 )726-3753. FAX(541 )726~3689
SPRINGFIELD '':'':'f-X,-OW:~1
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DEPARTMENT USE ONLY
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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" 0 Yes 0 No
CATEGORY OF ,CONSTRUCTION
D Residential I D Government D Commercial
'.i','c"JOB SITE INFORMATION AND lOCATION,
Job site address: /5 Iq l:5 S.,--
'l ./' I State7'JtV ZIP: 9 /7 / I'
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DESCRIPTION OF WORK
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PROPERTY OWNER
Name /77;,../ -' ~ ~ /l) Q,J\ nn .fl.,
Address: 1579 77 L<:.:'T
City: ~t'Z- I StateTru ZIP:~ff / /
Phone: ' - - Fax: - -
City: <::'
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Reference:
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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 rent. OAR
479540(1) and 479,560(1),
Signature:
CONTRACTOR INSTAllATION
I Business name: u,a( U, . ~". ',. r-II..M J-r:-n IJ..(I
Address: 4'C"3~ ~' llll/A A~tl~.::? D:1
City: hAl1~;;1.( I State: 011 zIP:nlot:
Phon;t7!t-7114<<lf?1 Fax 9tllift4L6(/C;
E-mail: /?rr." A/.v<~1.-":,, t..J',(::L. ~,I ~ (l(>,~
CCB license no,: /1. [?Qt;/ BCD license no,: "'1t')..t/{If:'(I
I Signing supervisor's license no.: l/it.((J< ..
P~int name of signing supervisor: ~ fttJ. '.tlTk~'",,-~
Signature of signing supervisor: --n... A 71 , J\ '
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440-2584-J (9/08/COM)
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" " FEE SCHEDUL:E' '. ' . \,
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Number of inspections per item () Qty, Cost I Total
ea, cost
Residential, per unit, service included:
1,000 sq, ft, or less (4) 5134,00 5
Each additional 500 sq. ft. or ponion I S 25,00 I 5
thereof
Limited energy (2) I 5 32,00 I s
Each manufactured home or modular 563,00 I 5
dv,'dling service or feeder (2)
Services or feeders: installa/ion, alteralion, relocation
200 amps or Jess (2) 1/ S BLOO 1 S ~. fP
20 I to 400 amps (2) I 5 96,00 5
40 I to 600 amps (2) I 515B,OO I 5
601 to 1,000 amps (2) I 5205,00 I 5
Over] ,000 amps or volts (2) I I 5469,00 I S
Reconnect only (2) S 63,00 5
Temporary services or feeders: installation, alteration, relocarion
200 amps or Jess (2) $ 63,00 5
20] to 400 amps (2) I S B7,OO S
401 to 600 amps (2) 5126,00 S
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteralion, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee;
Each branch circuit I \ S 6.00 \ s
b. Fee for branch circuits without purchase ofa service or feeder fee:
Fir::;t branch circuit (2)
Each additional branch circuit
5 55.00 I 5
5 6,00 I 5
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel.
alteration, or extension (2)
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.APPLlCANT 'USE.
5 63,00 S
5 63,00 I 5
I S 63,00 I 5
I $58,00 I S
Each additional inspection: (l)
I
I
(C) Technology Fee (5% of [A]) I
TOT AL fees and surcharges (A through C): 1
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S Ll/U J
5 q ,"IV
5 /;' I
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(A) Enter subtotal of above fees
(Minimum Permit Fee 558,00)
(B) Enter 12% surcharge C 12 x [A])
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
INWW. ci .springfield. or, us
permitcenter@ci.springfield.or.us
RECORD No:'s'ri-sPR20kb0691
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-". 224-00000-426102 $81.00
1 00-00000-425605 $4.05
821-00000-215004 $9.72
TOTAL DUE: $94.77
r pAYMENT :TIVPE.',,;I;,PAY:OR,;''t::,CASHIER!NKio;c8,i,oo';'', CONHViENTS'::',-<>.::';''0'F!', - , . AMQJJNT.PAID '
Credit Card BEAR MOUNTAIN ELECTRIC Process credit card transaction per $94.77
LLC Chad at Bear Mountain Electric
(DESCRIPTION' ,,' ""
Services 200 amps or iess
Technology fee (5% of permit total)
State of Oregon Surcharge (12% of applicable fees)
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RECEIPT NO: 2010000090
DATE: 0811912010
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096422
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