HomeMy WebLinkAboutPermit Electrical 2011-1-6
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Electrical Permit Application
225 Fifth Street. Springfield, OR 97477+PH(541)726-375H FAX(54 1)726-3689
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$1.6:1- 00 98(
-I'enmt no.:
Date: 1- b - /1
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 snspended for 180 days.
,. - '::~OCALi:'G0VERNMENT.'ApPROVA.@i-.M"}i',,"'1X-~Y.
Zoning approval verified? 0 Yes 0 No
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Reference:
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ZIP: 97'-(78
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Name:
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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'
479.540(1) andW60(l) ,:
Signature: /~ R~ '
:;CONTRAC'1;oR INST ALL)\TI0N
Business name: 0 LJ tV G<L
Address:
City:
Phone:
E-mail:
CCB license no.:
Signing superv' or's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or"portion $ 25.00 $
there.of
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 $
40 I 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 $
401 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 branc~ 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 ':lot 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: (1) $58.00 $
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(A) Enter subtotal oZto~ $ ~8
(Minimum Permit e 5
(8) Enter 12% surcharge (.12 x [A]) $ b ~b>
(C) Technology Fee (5% of ["'Jl.. .rm'l $ 2 ?o
r1'~ ~"'p ~~yu'~I-l!i.lrnL ~v'" $ b 7 ~-
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ATTENTION: Oregon law requires you to \'" 'I
follow rules adopIed by Ihe Oregon Utility
NoIification Center. Those rules are set forIh "*
in OAR 952-001-0010Ihrough OAR 952-001- I
0090, You may obtain copies 01 Ihe rules by,
calling Ihe cenIer. (Note: the telephone. NO~ICE:
number 10r the Oregon UIiliIy Notification THIS PER
Center is 1-800-332-2344). AUTHORILt
COMMENCED OR IS ABANDONED FOR
440-2584-J (9/08/COM) ANY' 180 DAY PERIOD.
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541.726-3753
www.cLspringfield.or.us
811-SPR2010-00981
7063 ASTER ST
permitcenter@ci,springfield.or,us
RECEIPT NO: 2011000055 RECORD NO: 811-SPR201 0-00981 DATE: 01/06/2011
tOESCRIBTION::;.' ::":' ;""-' 'I:,-o:+\r..:i:..:'; " :ft."'0:~-TT1l"t (sAC'c6UN:tcobE~- '':::'~~~c'''I,i:AM6uNtOUE':':..'-- ,;- g
Inspection Fee Adjustment - Electrical 224-00000-426102 58.00
Permit Fee Adjustment - State Surcharge 821-00000-215004 6,96
Permit Fee Adjustment - Tech Fee 100-00000-425605 2,90
TOTAL OUE: 67,86
b .~I'AYIV1EN-Fif;YPE:,;;, ,I'AYOR0~0#'CASHIER"'<BO\,\iL~BY ',"Jf'- 'COMMENTS,';:,,~,::::--:"--:-I-r, ""AMOUNT P Aio:
Check albert killion I add min electric $67,86
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3617
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TOTAL PAlO:
$67,86