HomeMy WebLinkAboutPermit Electrical 2010-10-7
Electrical Permit Application
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225 Fifth Street+Springfield, OR 97477+ PH(541)726-375H FAX(541)726-3689
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Permit no.:
,
Date: /0 ~ 7-/0
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 snspended for 180 days.
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Zoning approval verified? DYes D No
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o Residential 0 Government ommercial
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Job site address: ~SJ
e
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Name: &-0/ LL'-
Address: 'Pc::. aoy 70c{7)
City: teu-.C>+.....6T StateOL, ZIP: 't?f('::' (
Phone:
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(1).
Fax:
Signature:
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'Business name: J[ LA.{
Address: 3'6 -'-/
City:
Phone:
E-mail:
CCB license no.: ~ S- BCD license no.:
Signing supervisor's license no.: 100-5
Print name of signing superVisor:
Signature of signing supervisor:
I. t
Ulre. YOLl 0
ref Dn Utility
Notification Center. Those rul s ,re sr;\ forth
in OAR 952-001-0010 through AR 952-001-
0090. YOLl may obtain copies of the rules by
calling the center. (Note:the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
440-2584-J (9/08/COM)
Residential, per unit, service included:
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 $
$ 2S.00 $
$ 32.00 $
$ 63.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
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, re/ocah'on
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 s~ction above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase ofa service or feeder fee:
Each branch circuit
$
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00
$
$
$
Each additional inspection: (I) $58.00 $
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A])
(C) Technoiogy Fee (5% of [A])
TOTAL fees and surcharges (A through C):
$
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www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00450
3555 GATEWAY ST STE 103
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield, OR 97477
541-726-3753
permitcenter@ci,sprfngfield.or.U5
RECEIPT NO: 20 I 0000503
RECORD NO: 81 I-SPR20 I 0-00450
DATE: 10/07/2010
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Services 401 to 600 amps 224.;..000'!.o:.426102 $158.00
State of Or~90n Surcharge (12% of applicable fees) 821~,!?00:.215004 $18.96
~!:.?Iogy fee (5% of permit total) 1 00-00000-425605 $7.90
TOTAL DUE: $184.86
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Credit Card
220257
JEM ELECTRIC INC
$184.86
$184.86