HomeMy WebLinkAboutPermit Electrical 2010-11-4
Electrical Permit Application
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>\C~TY OF SPRfNGEIELD, OREGON ·
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225 Fifth Street. Springfield, OR 97477.PH(541)726-3753tFAX(S41)726-3689
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DEPARTMENT USE ONLY
Sf>l. ZO 10 -00
Permit no.:
Date: I. - '-( -( 0
This permit is issued under OAR 918-30.9-0.0.0.0.. Permits are nontransferable. Permits expire if work is not started within 180.
days of issnance or if work is suspended for 180. days.
Address: Co,)
City: S{>C-,d <f> ZIP: <774-,
Phone:$1-I't 5""Zj- ~., 0
E-mai]:
CCB license no.: i4,~ 74) BCD license no.: 20-4 (; C
Signing supervisor's license no.: .q 77;), S
Print name of signing supervisor: I'>1I~M'-
Signature of signing supervisor:
ATTENTION: Oregon law "e :.
follow rules adopted by th; Oregon Ul1lity \ ~V D
Notification Center. Those ru~e~t~e~;~_~~~~ \.Y.\f\W~
in OAR 952-001-0010throug ~'~
0090. You may obtain copies of the rules by ~.
calling the center. (Note: the telephone . u..
number for the Oregon Utility Notlfl~atlon \J'-'-
Center is 1-800-3~t;l:r4~E.
THIS PERMIT SHALL EXPIRE
AUTHORIZED UNDER THIS PE
COMMENCED OR IS ABANDONED FOR
440-2584-J (9!08/COM) ANY 180 DAY PERIOD.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
./
13'Residentia] 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
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Reference:
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fet-
PROPERTY OWNER
0~ ~q~,
Phone: 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 intended for sale, exchange, lease, or rent. OAR
479.540.(1) and 479.560.(1).
Signature:
CONTRACTOR INSTALLATION
Business name:
-
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service includ<<:d:
1,000 sq. ft. or less (4) $134.00 $
Each additional 50.0. sq. ft. or portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or fceder (2)
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 $
60] to ],000 amps (2) $205.00 $
Over 1,000 amps or voits (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: instal/ation, 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 $ 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 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 subtola] Of~ $ s-8
(Minimum Permit e $58.
(13))~~Jer..I2% surcharge (.12 x [AD $ 6~
I Fee (5% of[AD $ 2-10
mtill\Y1\SL!fOI and surcharges (A through C): $ i.,&
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. ., .
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR20,~0-00646
980 PRESCOTT LN
CITY OF SPRINGFIELD
225 Fifth St
Springfiefd,OR 97477
541-726-3753
permitcen1er@cLspringfield.or.us
RECEIPT NO: 2010000749
RECORD NO: 81 I-SPR2010-00646
IlATE: 11/04/2010
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" Ac.<::.o.liN:r:.C.Q[jE~_,_: - .AI'II_0_U~:r~D_U!:...:.:...:: ~. ~
$55,00
$3.00
$6.96
$2.90
$67.86
AN(9(jNT'PAID;~:'q,-
. J
[Q.!:~_<<BIPTIO~"'-.,:';' "';; ~I~___::_::l:~:' ;~c,
Branch circuits without service or feeder - 1 st circuit
224-00000-426102
224-00000-426102
821.00000-215004
100-00000-425605
TOTAL DUE:
l,~P'A YMENTTVPE,f':i&4-PAYOR' ;'_;',Ci~HfER: DBo~:+Y-+::i;_Qr;1'I'!IE~~ls~=,.z0 .''-':;'' ' ~ ,.,,'" I
Balance of Minimum Electrical Permit Fees
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
Credit Card
028192
milchell pratt
$67.86
$67.86