HomeMy WebLinkAboutPermit Electrical 2011-1-3
~cal Permit Application
CITY OF SPRINGFIELD, OREGON
225 Fifth StreettSpririgfield, OR 97477t PH(541)726-3753t FAX (54 1)726-3689
I DSZ- JMA-N"
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DEPARTMENT USE ONLY
SP(/.. 'ZD(I-OO c) 0 I
Permit no.:
Date:
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.
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes D No
CATEGORY OF CONSTRUCTION
o Residential 0 Government Commercial
JOB SITE. INFORMATION AND l
City:
Reference:
ZIP:
"7 '3 S 4. , Taxlot.: 01.( tOt!
DESCRIPTION OF WORK
Address:
City:
Phone:
E-mail:
This installation is being made on residential or fann 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).
ZIP:CPC177
Signature:
CONTRACTOR INSTALLATION.
~
Address:
City:
Phone:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
/
on laW requires youto
ATTENTION: Oreg b the Oregon Uti\lty
follow rules adoPte~ho"se rules are set for~
Notification ce~t~~1 0 through OAR 9521-00 b~
in OAR 952-00 - . co ies of the ru es
0090. You may obtain Nofe: the telephOne
calling the center. ( Utility NotificatIon Cl ~
the Oregon ) K""
number for ., _800-332-2344 . ....~'-=l~'-
center IS I ~ ~
440.2584-) (9/08/COM) Y
~
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit. service inclu~ed:
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)
Senrices or fceders: insiallation, 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 $
20 I 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:
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 feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, d, $ 63.00 $'~, j)
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ I d.lJ.P )
(Minimum Permit Fec S58.00)
(B) Enter 12% surcharge (.12 x [A]) $\'5,\d
(C) n~qI9ll):ree (5% off A]) - $ p.~r )
To'fA:L'i~~'" d,~1 r,<~ ; w-". ~'-1~ wcs: K.C/.l
"'''H~ ~\i-~~llj Pr.~E~~ rrn~ 'l
I I IIV I 1... ~I'" , .. NO
'd,
AUTHORIZED UNDER THIS PERMIT IS
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
III..
SPRIN~~ FIE.~ . .
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'.~ . OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00001
1082 MAIN ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000001
RECORD NO: 81 I.SPR201 1.00001
DATE: 01/03/2011
tD'E'S' C'R' IPTIO' 'N'" . ~ .:;~ ,;,s;';',4/C'C'..C,.',. "-.'-(."'{f.:' .'r. h.A..C....C.O..UN--T"'C.ODE...:c;.
._____:..;..,.---:~'. ,-"'_""'_~ '. ,. "."': -.._ '.5.... _'" . ~ '\,.. -5-,,~~L~.__.__..-,____;,1..: __.'m_."d"
. Signal circuit(s) or limited-energy panel, alt~~atj<?n, or extension 224-00000-4~6102
Iechnolo~y fee (~~!?ermit total) 100-00000-425605
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
~~~---_._-~..._._-~-_.' .---- ----------
TOTAL DUE: $147.42
L. PAYMENT;TYPE..~PA.Y:O.R...:CASHIERDB6w,sB{<:; IC,OMMEi-!:CS:c'2 :':i-~.__."":':_.:~":""I\i1Qur'UJ~~U?_ ...__'..'
:" ,':i~Q@T DUE'~:" :..c..-J
$126.00
$6.30
~--,..~.,_....,--
$1512
Check
41144
OMLlD & SWINNEY FIRE
PROTECTION & SECURITY
$147.42
$147.42