HomeMy WebLinkAboutPermit Electrical 2010-11-5
Irle~t.rical Permit Application
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1~!lFY OF SPRIN~Ji1l!!J[P'. -q~G~N_ .
225 Fiftb Street+Spdngfield, OR 97477+PH(541)726-3753+ FAX(54 1)726-3689
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DEPARTMENT USE ONLY
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Penn it no.:
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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
esidential 0 Government 0 Commercial
JOB SITE INFORMATION AND lOCATION
Job site address: 'D ~ \ If fI Lv
City: 5 r' fl., State: D><.-- ZIP:
Reference: 17C 5 'Z Taxlot.: 0
DESCRIPTION OF WORK
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Name:
Address:
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).
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Signature:
CONTRACTOR INSTAllATION
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Signing supervisor's license no.: :t-
Print name of signing supervisor: (J
Signature of signing supervisor: :t-
. on law req Ire:; ,uu '" .
ATTENTION. Oreg d b the Oregon Uti!,\\
follow r~les adopteTh.!se rules are set ionn
NotificatIOn Center. h gh OAR a~2.001.
. OAR952-001-0010t rou . "".eb-
In obtain copies Oflhe n,,~'" - \
0090.. You may (Note: the telephone n J
calling the c~n~;'egon Utility Notification, t\y ..;:;;J
number6~~:e:is 1_800-332-2344). \.JV ,\$ ~t-P
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440-2584-J (9/08/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additionat 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) V $ 81.00 $ '><-1
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 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 I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or fteder 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 $
(Minimum Permit Fee $58.00) 8'1
(B) Enter 12% surcharge (. t2 x [All $ ?72.
(C) Technology Fee (5% of[A]) $ l(of"
1t;~i}C ~s and surcharges (A throggir C), $ 91./71
HAL EXPIRE IF THt ..
THIS PERMIT S L
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
...
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00669
530 SPRINGDALE AVE
CITY OF SPRINGFIELD
225 Fifth 51
SprjngfjeJd,OR 97477
541-726-3753
perm itcenler@ci.springfield.or.us
RECEIPT NO: 2010000774 RECORD NO: 8 I I-SPR201O-00669 DATE: 11/05/2010
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Services 202. a"!ps or less 224-00000-426102 $81.00
Technology fee (5% of permit total) 100-~000i425605 $4.05
State of Oregon Surcharge (12%01 applicable fees) 821-00000-215004 $9.72
TOTAL DUE: $94,77
1- P.~J:MENTTYP~;:~,:t~'yOR:'-;;C1'cSHjEf'-bBi:iWLSBy:,uYC9J'~_N1J:NJ:S"'t';.';:: ,'. " ~,,;At~'LQuQtlI,eAID;-,-;'.... .~
Credit Card
628828
BOB FISHER ELECTRIC INC
$94,77
$94,77