HomeMy WebLinkAboutPermit Electrical 2010-12-2
Ele~.trical Permit Application
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225 Fifth Street+Springfield, OR 97477.PH(541)726-37S3.FAX(541)726~3689
DEF'ARTMENT USE ONLY
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Permit no.: ~\\)"(~Nb
Date: ~ "9./ \ 0
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is Dot started within 180
days of issuance or if work is suspended for 180 days.
PROPERTY OWNER
Name:
\
I
I
City:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member afmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS A["'.NJONED FOR
u ry 1 :~Q D v nerd -
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~
440-2584-J (9/08/COM)
FEE SCHEDULE
Numberofinspections per item () Qty. Cost Total
ea. cost
Residential, per unit, sen-ice 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)
Sen-ices or feeders: installation, alteration, relocation
200 amps or less (2) \ $ 81.00 $9;1.0 b
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 services or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $ ~
201 to 400 amps (2) $ 87.00 $
40 I 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:
" __ ._.,.....,. ("'\~"...."n 1~\M rHfltJllt;;:) VU'-'I ,.....
Each 22.w~~~J(:'M!!~ '~doot~d by t 1e 0 e(P6.oo'i It.~
b. Fee forJranchlcircuits~withouiTpufchasel'o('a'servlce:orlfeeaer fee:
I'll llll..........'~..- _.. .._k("'^QUj..,....._llll\_
F' ir ("'\ hP.OL.,~Jl:iVl-VU I v Llll..... ,~., . f t~c55cOO. L ISy
Irst r~c_ c~r,cUl.t. ..",,..,I--..t';lin r.Of ies (
Each ~d~ii.~Rn~~rM~it~}r~~l. (Not l: th( t($~~:o6'1 e~
. - '... .:~ (I"(::Ir'''W''I I p.IIIlV '\I' Hill.....!;."'.....'
MlscellaQIfl!t,l1i; 'ees:fserVJcil?r!f.ee'1if!;,n9-l..1!1,c(lf_q~f{i \
Each pump or irrig~i{6Rlh'~cie(:i)u""v ....... $ 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: (I) $58.00 $
. APPLICANT USE
(A) Entcr subtotal of above fees $~(.OO
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x IAll $q ..'l~
(C) Technology Fee (5% o[(A]) $L.,O~
-TOTAL rees and surcbarges (A tbrougb C): sQf!17
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00815
2344 BEVERLY ST
CITY OF SPR[NGF[ELD
225 r'ifth Sl
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield,or.us
RECEIPT NO, 20[0000956
RECORD NO, 811-SPR2010-00815
DATE, 12/02/2010
, AC,C9,Ut{rlC9J),E ;"~;'~:);'0AMOUNTDUE._,,:;c;
224-00000-426102 $81.00
100-00000-425605 $4.05
821-00000-215004 $9.72
TOTAL DUE: $94.77
t:..,p~Ycl'lll:Jit.:IY~.E~:'J~A~@~~2.~HIERNMACHA5'o.,-, )C:QMME~I$;?S':-' ;-;=:' "-" ,;,} ;- W:-1o_UJjI'pAii:L~'
ibESCRIPTIC)N: ..:..;J,. :':;:- 7i-",~~ ~'S,'l.-'-'- '-elf ;'~''::'-::.~:'' ',.
Services 200 amps or less
Technology fee (5% of permit total)
State of Oregon Surcharge (12% of applicable fees)
'1
. ..,
, d
Check
1562
BHM ELECTRIC COMPANY
$94,77
$94,77