HomeMy WebLinkAboutPermit Electrical 2010-10-29
Electrical Permit Application
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225 Fifth Street+Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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Date: 0 -2 'i'- / 0
This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for ]80 days.
., " '/I.:OCAL::GOVERNMENT'ApPROVAI5';.,.,,{C'!!sj';'r":
Zoning approval verified? 0 Ves 0 No
;; ::~',.",',,'a.CMEGORY#bF ;>C()NSTRUCtlbN~~!' ,.:
o Residential 0 Government 0 Commercial
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Job site address: 4 f l \.0 S\ .
City: S \ State: Oil ZIP:
Reference: '703 z. ., t{ '< Taxlot.:O
. >DESCRIPTION,OF'WORK'"''
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Name:
Address:
ZIP: '71( 11
City:
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).
Address:
l.j :;l-l[
Phone:
E-mail:
CCB license no.: '07 S'"o Co'
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
NOTICE: . HE WORK
THIS PERMIT SHAll EXPISR~~~~IT IS NOT .
AUTHORIZED UNDER THI
COMMENCED OR IS ABANDONED FO~{\./"'"
ANY 180 DAY PERIOD. ~:\~
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440-2584.) (9108/COM)
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.N ~~.~er' ?.fir.Sp~~i~~'~ip~[:'.~,t~,~; (;)jl>;;,' ,
.- ,.,. - - ~ "'~' --- .,'.- , ',', ~,.. ",h '1..,ell'.-~ , .. cas\' '.
Residential, per unit, service included:
1,000 sq. ft. ar 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 feeder (2) ,
Services or feeders: installation, alteration, relocation
200 amps or less (2) / $ 81.00 $ /f/
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, 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 se,;"ices or feeders section above
Branch circuits: new, aLteration, extension per panel
a. Fee for branch circuits with purch~se of a service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee forjtiranchlcirciiiis WlttioJItlpurcliase?6ft~s{;fVtce"d~lfteder fee:
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First bTf~Wth\:ti~Wii~(z)uulJu:::u uy u.v ,-" - ~~'~2i""OR;r?\1l
",......,.,T'...."'T"'n _:..3.I'"ltor Thnc::p IIIAS arc .....t I t
Each ~~'cjjtio.nah~ran'c)1cit",ultO throu gh 0 !\F$9:6?o6l 1 $
M' liMon tn:: me" O"'J~Pdp,O,PcI~S 91JI~ IUI'" uy
Isce aneo~~. _e~sl,!~~I~~Pr~ ,,}".....O,I{lCc>U e (.1l"\h no.
Each pumpo;;i;';'lg~i;;nfr(ci8i~~~;; U . . ~,$ti~,:l.;9.Q:C
jlity n$
"l"l-Jl:;'. "..11"'-' .
Each sign or outlirG'ligiifiii~f(2\.800-3' 2-23 FsJ '63,00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
'5k~A#~~~!-""8~~i:t.~I~~{~;~'RefficANft~jusi:1fui;t('!*"Z:~jf~:~I~~'{~~Ii;~:i!,;1:.-::~::"
(A) Enter subtotal of above fees "
(Minimum Permit Fee $58.00) $ 81
(B) Enter 12% surcharge (.12 x [AD $ ~7L
(C) Technology Fee (5% of[AD , $ Lf OS"'
TOTAL rees and surcharges (A through C): $- -~
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0',#mOREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR20 10-00613
481 W N ST
CITY OF SPRINGF]ELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
perm itcenler@cLspringfield.or.us
RECORD NO: 8] I-SPR201O-006]3 DATE: 10/29/2010
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224-00000-426102 $81.00
100-00000-425605 $4,05
821-00000-215004 $9,72
._---~~~
TOTAL DUE: $94.77
12~YMENT,iTYPE'~. 'PAYOR;,C::C6sH1ERD8oWt'SBt,:!icQMI1ii~Nf$""A;';~".: ' :h:,:,:xiAMP.UfolTP-e,LD' tL~..J
RECEIPT NO: 20 I 0000708
IDESCRIPTIO, N:': "+,'C;:,
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Services 200 amps or le~s
.!echnology fee (5% ~of permit total)
State at Orego'n Surcharge (12% at applicable tees)
Credit Card
010041
MY ELECTRICIAN INC
$94.77
$94.77