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HomeMy WebLinkAboutPermit Electrical 2010-12-2 Ele~.trical Permit Application fFm @[li'~ml1J])g<ID~~ 225 Fifth Street+Springfield, OR 97477.PH(541)726-37S3.FAX(541)726~3689 DEF'ARTMENT USE ONLY I~ 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 - \~ ~ 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