HomeMy WebLinkAboutPermit Electrical 2010-12-21
Electrital Permit Application
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225 Fifth Street. Springfield, OR 97477.PH(541)726-3753tFAX(541)726-3689
SPRINGFIELD
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This permit is iss'ued 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
'!;;.;;;:"i:':.i:CATEGORY3C5F,~c:ONSTRUCTION',.1!.. '."
D Residential D Government D Commercial
~J(~~1l0B~SITE;'iINFQRNlATIONfl'AND?;;IZ()-CA;r,I()N~~)li*.~'!i:ll
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City: C 7<: ZIP: ci 7'17 '7
Reference:' 70'S Z. 7:3 ( Taxlot.: 00 C
. 'OESCRIPTIONi..'OF'WORK,;j;"_\::;-,";,\,,V::;,/''"
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Name:
ZIP C; 747?
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 .S40( I) and 4 79i/S60,~1 ).~__
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Signature: "':J:~/ 'LA t4' /
,.CONTRACTOR INSTALLATION
Business name: C?l"'I'{M
Address:
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City:
Phone:
E-mail:
CCB license no.:
Signing supervisor's r ~f\T;19~;~ . ~
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Print name of signi sUpl!tvisot:s adopt~d bv thp. rAn I Iti!:
OllT/Cellon C t T ~ - '''.
Signature of signin&1 ulJer.\(i~or,; f1 en ;~. ~ose r~le~ ~~e set for h
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0090,. You may obtain copies of the rules b
calling the center, (Note: the telephone y
number for the Oregon Utility Notification
Center IS 1-800-332-2344).
NOTICE: ~\J ~~~~~.
;~~H6ERM'T SHALL EXPIRE IF THE WORK W
COM RIZED UNDER THIS PERMIT IS NOT tJ'
MENCED OR IS ABANDONED FOR
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440-2584-) (9/08/C>:OlvU) RIOD.
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,N u~~er Ofi~fi~~~ii~ri{p~rit~~,(S,'.;-IQfY. . Cost. '" 'Totar
',," ..'" ...<, """"'''"'''',''''''1 "". ',";",'; ,"_<, ),1_ :~~'i'. , I. cost. "
Residential, per unit, service included:
1,000 sq. ft. or1oss(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 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 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders sectj~n above
Branch circuits: new, alteration, extension per panel
a, Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purch~se of a service or feeder fee:
First branch circuit (2) I $ 55.00 $ . ~
Each additional branch circuit I $ 6.00 $ h
Miscellaneous fees: service or feeder no! included
Each pump or irrigation circle (2) $ 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 $
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(A) Enter subtotal of above fees {,(
(Minimum Permit Fee $58,00) $
(8) Enter 12% surcharge (.12 x [A]) $ 77Z
(C) Technology Fee (5% of [A]) $ 30,)
TOTAL fees and surcharges (A through C): $7/77
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~OKEGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2010-00948
820 W QUINAL T ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci,springfield.or.us
RECEIPT NO: 2010001108
RECORD NO: 81 I-SPR2010-00948
DATE: 12/21/2010
State of Oregon Surcharge (12% of applicable fees)
TechnologY fee (5% of permit total)
C4/'/ -""".'\;,-,"'C_COJJ}j:r~C-')DE -'-/;j;.;i ii- AM.ctUllIJ>.UE:,
224-00000-426102 $6.00
224-00000-426102 $55.00
821-00000-215004 $7.32
100-00000-425605 $3.05
_..._-----
TOTAL DUE: $71.37
,PAYOR/ iCASHiER:DsCl\:t?ffis\'.j;.'(',,-:G:()lytllllE:J'iI$.Li: '. ':". ; 'r;1, ':;'-'1;' Al'i1buNTP~'-!b. .'
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I DESCRIP:J'f9N;~f.~;'i{::... .' .",,-
Branch circuits with service or feeder each circuit
Branch circuits without service or feeder ~ 1st circuit
D:..PAVMENJ;TVPE
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Credit Card
00632c
michael harts field
$71.37
$71.37
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