HomeMy WebLinkAboutPermit Electrical 2010-11-4
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tlec\rical Permit Application
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~fit~l"Y OF SPRINGE~~~I)' OREG9N. .
225 Fiftb Streett Springfield, OR 97477+PII(541)726-3753+ FAX(541)726-J689
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DEPARTMENT USE ONLY
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Date: .
This permit is issued under OAR 918-309-0000. Permits are nontrausferable. 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 Ves 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government '/Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: -z. 6 7'3' {. iL< Y
City: b jJ ;tA/If ^;: /21 State: CJ,( "IJ-il
Reference: f/...'1t4N S'rltAfU1/ Taxlot.:
DESCRIPTION OF WORK
C. (6-(+ iI' It',
C> C 2. z..
PROPERTY OWNER
rL-s. -LL~
Address: ~~s:.~Jha.A- Si
City: > 1/1. (<-<- State: (} /I ZIP: 0/ -. '-I 11-
Phone:"i4/ -1'11 - IN1 0 Fax: 1f'lI- Fit 1&1/,
E-mail: IS'., ( IT th.4tli? ~;0~It/'a
This installation is being made on residential or farm p'toperty
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:
Name:
/ -
-[
Signing supervisor's license no.:
Print name of signing supervisor: I
Signature of signing supervisor: ______
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 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 $
201 to 400 amps (2) . $ 95.00 $
401 to 6QO amps (2) $158.00 $
601101,000 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. Fec for branch circuits with purchase ofa 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 fteder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) t(' $ 63.00 $ 6'~.Cl
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ b>
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD $ '1'rG
(C) Technology Fee (5% of [A Jr"'. $ ir.r
F M\ilI'WJlIel:sDlili'lIiIfcli~ C): $ -,? 71
IZED UNDER THlti r"rlIv.! I I" I~U I /j
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ATTENTION: Oregon law requires you to :$'
follow rules adopted by the Oregon UtilitY~~r J \)
Notification Center. Those rules are set forth \y ~
in OAR 952-001-0010 through OAR 952-001- X ~
0090. You may obtain copies of the rules by ~
calling the center. (Note: the telephone N OTI CE
number for the Oregon Ulility Notll;?Catlon
Center is 1-800-332-2344). THIS PE
AUTHOR
\0 COMMENCED OR IS ABANDONED FOR
-::r- .&' ANY 180 DAY PERIOD.
440-2584-J (9108/COM)
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Spr~NG':.IE~.-
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. ~OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00657
2053 LAURA ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726.3753
permilcenter~ci.springfield.or.us
RECEIPT NO: 2010000757 RECORD NO: 81] -SPR2010-00657 DATE: 11/04/2010
IDES9RIF'tION?';"~n, ",,';r:;:~:;-~-- ';!~''t_';7;';._ ::... .'- ;AC.G.o_U~J~c.o:riE-.- c;'C;;;;':~~l,iLOj.!N'TD_UI: - . .; - ';j
Sign or outline lighting 224-00000-426102 $63.00
Technology fee (5% of permit total) 100-00000-425605 $3.15
State of.2regon SurchargeJl2% of applicable fees) 821.00000-215004 $7.56
TOTAL DUE: $73.71
I. _p.~Yrv'l.l:.rfl'jYP~':';~;:'J1AYdR'7h;CASfiiERDBOWLSB'i ~;.;<::_QMME.Nt:S-;i;_!:,_- - ." --~~;~AMOUNT PAID no ;"~
Credit Card
b72263
MIDNIGHT ELECTRIC LLC
$73.71
$73.71