HomeMy WebLinkAboutPermit Electrical 2010-10-27
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Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
2251.ifth Street+Springfield, OR 97477 +PH(541)726-3753+ .FAX(541)726-3689
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. . DEI:'ARTMENTUSE ONLY
5f.1L 2010- 00.5'4.0
PermIt no.:
Date: /0 -'l..7-(()
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
I~esidential I D Government D Commercial
JOB SITE INFORMATION AND LOCA.TION
Job site address: Zll to{ ( st
City: S:t'f h I State: ~ I ZIP: <=) 7Cf TI
Reference: 110 ~ z. b ( 3 I Taxlo\.: ,.., I Z-lO
DESCRIPTION OF WORK .
S~ / 61t.~ WIU
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,.' ...'. . PROPERTY OWNER
Name:~(-,.H- {' v\..............,- 'i:
Address: ? I ( '-l. ,. \ rt-
City: <"O)tC ~ 1 State: ~ 1 ZIP: ., 7C(77
Phone: - - I 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 i.ntended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION .' '
Business name: m :.,.~ rl( ,J."At/ OM0l1vJ I h/leb r!.TPt I
Address:::!1s:J. I- IMlI' M ( ..U--:. ( 7
City: rJJ(),.p;nC, 1 State:()~ 1 ZIPQ7i/O;J...::JJ
Phone:9//J;;j fL2.S<7 I Fax,..LJI/4f;) :./,,;.,
E-mail:t'AArr") vr./I.. . I. I { . J .n /'.~ rn d._ ./tJ/-
CCB license no.: t"i6)f!Y/ I BCD license no.:.;/o- 3/7G
Siglling supervisor's license no.: .i./,'-,Jf?-S
Print name of siglling supervisor: 1i1(j 1'1-; '" A ,,,1_ (; Jr-',
Signature of signing supervi""", 111 /1 ..1:7\ ~ (
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. FEE SCHEDULE
Number of inspections per item () I Cost Total
Qty. ea. cost ,
Residential, per unit, service included:
1,000 sq. ft. or less (4) I $134.00 $11L(
Each additional 500 sq. ft. or portion .3 $ 25.00 $7S
thereof
Limi[ed energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Scn-ices or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20] [0 400 amps (2) $ 95.00 $
40 I to 600 amps (2) $158.00 $
601 [0 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
ReCOIlllcct only (2) $ 63.00 $
Temporary services or feeders: installation, alteration. relocation
200 amps or less (2) $ 63.00 $
20110400 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
1$6.00'$
b. Fee for branch circuits without purchase of a sefVice or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 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: (I) $58.00 $
"APPLICANT USE .
(A) Enter subtotal of abOve fees
ATTENTION: Oregon law requires you to ~) \SJ (Minimum Pcrm.i!;J::~~$58.00)
follow rules adopted by the Oregon Utility W,,:\~. '" (B) Enter 12% surtli!,!&c-(12 x [A])
Notification Center. Those rules are set forth \. ~ (C) Tcchnology Fe.;-(5%0f:[A])
in OAR 952-001-0010 through OAR 952-001- ~ ,::.:;' :', ::",,-'
TOTAL fees and surcharges (A through C):
0090. You may obtain copies of the rules by ~,
callmg the center. (Note, the telephone ~~\.. :OT/CE:
Q"mhpr fnr ]1;1,.e Oregon Utility Notification ~
440-2584-n9/~ifri\~1 is 1-800-332-2344), THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY j 80 DAY PERIOD.
,
$ 2.0 '7
$ 7:50::
$ IOy.
$':""1 S~
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00540
2114 7TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECORD NO: 811-SPR2010-00540 DATE: 10/27/2010
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224-00000-426102 $134.00
224-00000-426102 $75.00
821-00000-215004 $25.08
100-00000-425605 $10.45
TOTAL DUE: $244.53
~#PAYMENT<TYPE:;;: >:PAYOR',~"':Ct-~HIE~.:.b_BOW'SBY;~";.&bJk1i"J;J,,Ji$'~' <;;;~riF",,;'''l.\V:r -. ""AMO(}Nl-pATD"~ r.'
RECEIPT NO: 2010000682
rDESCR!PTION~j':?,_{ '.: 'V . -; .
Residence wiring 1,000 sq. ft. or less
Each added 500 sq. ft. or portion
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
1
Credit Card
04703c
michael gansen
$244.53
$244.53
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