HomeMy WebLinkAboutPermit Electrical 2010-11-3
Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
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225 Fiflh Street+Spriogfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
DEPARTMENT USE ONLY
~ Permit no.: S?~O .-..(i3J"
Date: \1 ~:s - 10
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is snspended for 180 days.
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION "
M Residential I 0 Government I 0 Commercial
JOB SITE INFORMATION AND lOCATION,
Job site address: '415 I Cto.\--U' ot)
Cityt::: 1.1 State:Oi<. I zIP'1'lQ'l'l
Referen:!.: \ 'In--v. 1AJL Taxlot.01 <gOO
cO"ESCRIP1"ON OF WORK I,
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,
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PROPERTY OWNER
Name:.~( L'\f-? JV\ ~? \o....~
Address: 32-10 t..-' ",","_ ~ ':- ''''p-- I
City:~~ f'> J State:~ I ZIP: Cj/< /^'
u
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:
CONTRACTOR INSTALLATION
Business name:-'t- 1\lVY' r:1 0 J W 10... LO
Address: .yO 60 1- Q.S ~L\
City: t'tl.1l. I State:<0R I ZIP: qf\'-\ 0:"
Phone:gt!\ li8to.-M D5 Fax5L/;1lR.2l.rt-c,l>f0
E-mail: Ot"[I1\'f.l.D ,j..(\~ }., t:0
CCBlicenseno.: IP/-iDOc., I BCDlicenseno.:Cl.\3~
Signing supervisor's license no.: \ F; b <6 ~
Print name of signing supervisor: Ehl' '"1-<6<;6
S. f" . / d.A A' ~
Ignature 0 slgnmg supervisor: /57 /'Y ~ 4.
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440-2584-J (9/08/COM)
FEE SCHEDULE
Number of inspections per item ( ) QIy. Cost Total
ea. cost
Residential, per unit"service included:
1,000 sq. ft. or 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 $'i((tJD
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) $.4,69.00 $
Reconnect only (2) . /$ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
20 I to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a Fcc for branch circuits with purchase of a service or feeder fee:
Each branch circuit
I
$6.001$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder not included
Each pwnp or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (I)
APPLICANT USE
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(8) Enter 12% surcharge (.12 x [A])
(C) Technology Fee (5% of[A])
TOTAL fees and surcbarges (A through C):
$ 63;00 $
$ 63.00 $
$ 63.00 $
$58.00 $
$ ;;?/~
$ 9.7.1
$ y.O!
$ QiJ.'l1
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~LLOR:eGON
www.ci.springfleld.or.us
TRANSACTION RECEIPT
811-SPR2010-00638
1415 WATER ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2010000738
RECORD NO: 811-SPR2010-00638
DATE: 11/03/2010
rOESCRi~TfoNh;:"\~t.:'l;~1', : "~"Ii;JC~5;;i:j; _:..-
Services 200 amps or less
Iechnolo9,Y fee (5% of permit total),
State of Oregon Surcharge (12% of applicable fees)
":~"Jtii- ." ~CJ;_QJ.lN;r.iC_Qi:>E-. ~t~,..T7"'b ~r.j9.l!NJ~Q.l!E ,> , .'
224-00000-426102 $81.00
.~._.~
100-00000-425605 $4.05
821-00000-215004 $9.72
TOTAL DUE: $94.77
. .I?Ayr.jtNT, TYPE,.' :,:pAy;QR~"" ''CAsHIER,ss"BA~'';'';C'.i'cJ:5ii1.MI:'NtS,~'N"y".",:-;''...:' ." '........"AMOUNl'PAIO...',.. ,
...... J
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Credit Card
147067
BHM ELECTRIC COMPANY
$94.77
$94.77
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