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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" ~~ 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.~ . . ~.;~~..... ~:' .~ '.~ . 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