HomeMy WebLinkAboutPermit Electrical 2010-10-1
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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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Permit no. : S , 0 .c:::c Lfl 7
Date 10 . 1 - ( 6
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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.
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Zoning approval verified? 0 Yes 0 No
" . . . ,,,'CATEGORY 'OF 'CONSTRUCTION
"1N'i<"i; '~' ~2\
Total
cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Residential, per unit, senrice included:
Job site address:
City:
Reference:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
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).
Signature:
" : :::,'''.'':CONTRACTbR''INSTAllJATlONE
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5'2
Limited energy (2)
Each manufactured 110me or modular
dwelling service or feeder (2)
Sen'ices or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $ 8
20 I 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 sen'ices or feeders: installation, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$126.00 $
#
Over 600 amps or 1,000 vOlls, see services or feeders section above
Branch circuits: new, alteration, extension per pane!
a. Fee for branch circuits with purchase of a service or feeder fee:.
Each branch circuit
b. Fee for branch circuits without purchase of a service or feeder fee:
E-mail:
CCB license no.:
$ 55.00 $
$
Signing supervisor's license no.:
Print name of signing supervisor:r
Signature of signing supervisor:
BCD license no.:
$
$
$
$
440.2584.J (9!08/COM)
NOTICE: '
THIS PERMIT SHAll EXPIRE IF THE WORK ~
AUTHORIZED UNDER THIS PERMIT IS NOT :"'\~
COMMENCED OR IS ABANDONED FORtY" \ \)
ANY 180 DAY PERIOD t;,., ..' .\
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(8) Enter 12% surcharge (.12 x [A])
(e) Technology Fee (5% of[AD
TOTAL rees and surcharges (A through C):
$ /11.00
$ /3.
$ 5.55
$ J2:1.8~
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2:: . OREGON
www.ci.springfield.OLUS
TRANSACTION RECEIPT
811-SPR2010-00417
3550 GA TEWA Y ST
CITY OF SPRINGFIELD
225 Fifth SI
Springfield,OR 97477
541-726-3753
permilcenter@ci.springfield.or.us
RECEIPT NO: 2010000712
RECORD NO: 811-SPR2010-00417
DATE: 11/01/2010
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224-00000-426102 $81.00
224-00000-426102 $30.00
------".-
821-00000-215004 $13.32
100-00000-425605 $5.55
TOTAL DUE: $129.87
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lQ!;:jCr{JP,TION -.~
.?ervices 200 amps or less
Branch circuits with service or feeder each circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
1
Check
33364
LANTZ ELECTRIC INC
$129.87
$129.87