HomeMy WebLinkAboutPermit Electrical 2010-9-20
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Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
225 Fifth Stree~.Springl1eld, OR 97477. PH(541)726-37S3. FAX(541)726.3689
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'" DE,~ARTMEtU USE ONLY
Permit no.: $/O.U'O J LI ,
Date: ~-ZC> -r t..::::
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days orissuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
IZI Residential D Government D Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: ff::i 8 0 LD 0 Q.Ul/f11..() LMJ E.
City: 5 livirFI"'-<...A State: DR.. ZIP: t17'177
Reference: i '1,. 03 ,- 2.3.-43 - Taxlot.: 03tJco
DESCRIPTION OF WORK
" I i' I \
v t"..~o~'r
.PROPERTY' OWNER.:
4.0
() l--D 0 R.c AiL!)
Name: l>A
Address: <? 5 f{
City:S; ,,' '-,
Phone5'i1 -7'il.- beo r;
E-mail: l1, ,-,-,,'\'r ':]... ~ C, - .:,,~1 .
This installation is being made on residential or fann 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).
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CONTRACTOR INSTALLATION
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Address:' 9.52 A
Signature:
City:
PhoneS11
E-mail:
CCB license no.: f 'I'" '
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervis .
ATTENTION: oregon law requIres you,t.o .
follow rules adopted by the Oregon etUtflhlyrth
Cent ~ Those rules are s 0
Notification .001~10throUgh OAR 952-001-
~.::: may obtain copies of the rules by
itn the center. (Note: the te'~~hOt~n )
n~b~r for the Oregon Utility NotlflCay, <\
, Center Is 1-800-332-2344)~ib~.
440-2584-1 (9/08/COM) ~
. FEE SCHEDULE
Number ofinspe~ti~ns.:peHtem q 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 energy (2) $ 32.00 ' $
Each manufactured home or modular $ 63.00 $
dwelling service or teeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 tto 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 senrices or feeders: instal/ation, aJ~er'!tio/},.r..elocatjon
~'...>.O) "~
201t~ ....\ '~)(J)?J'. . Gi1
401 to1iill\gnIjIl'.~}JI\~ :''' 1\-\ 13 \,1 " $: ...
Over 6ljQ&1iW:OP,I,~~~4IS "'..,. .ee ers section above
Branch(S@J'llj\ \e!i)nsion per panel
a Fee foAtXanchQ:ifdiiis' with purchase of a service or feeder fee:
Each branch circujt.._ I $ 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) j.. $ 55.00 $ S"5
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 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
; .." ..... APPLICANT USE
(A) Enter subtotal of above fees $ Sa.
(Minimum Permi~
(8) Enter 12% surcharge (.t2 x [A)) $ b'r.
(C) Technology Fee (5% of[A)) $Z'~~
TOTAL fees and surcharges (A through C): $b7O'::>
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00341
858 OLD ORCHARD LN
CITY OF SPRINGFIELD
22~ Fifth St
Springfield,OR 97477
541.726-3753
permitcenler@ci.springfield.or.us
RECEIPT NO: 2010000355
RECORD NO: 811-SPR20 10-00341
DATE: 09/20/2010
IDESCR!PTION~",,_,:: - ~,- q --. x.:'" . , - ... --~;'<Ac::_C0,tiNJ':'C_QRl;f3", '-'-' '''~r,,'tQ_UN:LRJ''E "'::-...:.:.1
Branch circuits without service or feeder - 1st circuit 224-00000-426102 $55.00
Balance of Minimum Electrical Permit Fees 224-00000-426102 $3.00
State of Ore90n Surcharge (12% of applicable fees) 821-00000-215004 $6.96
Technol09,r fee (5% of permit tot~ 100-00000-425605 $2.90
TOTAL DUE: $67.86
L_P"e,YMEl'!l..TXPE,), .,P.AYOR_,,~'cASHIERPB6$!SSBY,,--,-C9MMg(lj'(S..f"-'i:.; ... ":"":""""AMOUJ'!JJ'AIQ
Check
2402
double eagle design
construction
$67.86
$67.86