HomeMy WebLinkAboutPermit Electrical 2011-1-12
Electrical Permit Application
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753. FAX(541)726-3689
Phone:
E-mail:
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) and 479560(1).
Signature:
,: .1~~"''''ifIiTI!6'ii;t;,;r,'''R;i!lINS*'ii''!\I''''''I''';'.'l''f;f'~'lf.fS1i\~,"?~.;.
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Business name: ' S tlE<--
Address:
City:
Phone:
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1,000 sq. 1'1. or less (4) $134.00 $
Each additional 500 sq. ft or portion. $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or rnodular $ 63.00 $
dwelling service or feeder (2) Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
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 Dr feeders: installation, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
40 I to 600 amps (2)
$ 63.00 $
$ 87.00 $
$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 ofa service or feeder fee:.
Each branch circuit
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00
$ 6.00
I...c.. Miscellaneous fees: service or feeder not included
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
. ~t; :-..,\
NOTICE: s~ <\;
THIS PERMIT SHALL EXPIRE IF THE WJJ
AUTHORIZED UNDER THIS PERMIT IS ~
COMMENCED OR.IS ABANDONED F \};
A~IY 180 DAY PERIOD.
440-2584-1 (9/08/COM)
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
$ 63.00 $
$ 63.00 $
$ 63.00 .$
Each additional inspection: (I) $58.00 $
.I,.Wll!i~ggt(i;'A19ffliW$'
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD
(e) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through C):
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2010-00778
212 MAIN ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000081 RECORD NO: 811-SPR2010-00778 DATE: 01/11/2011
[D1~SCRIe,fl(:)NW'~-'\,,/;:. ,-,'-0 ~i:;-'. -,,:;:. . ":;:','1- "rTj-;;Y.,;:.-,,;::z."<'. <-' · ;i>.CCOtiNJcC.(:)DE ';' ,,',~,:?::bAM(:)UNU)UE~ ,"';j
Branch circuits with service or feeder each circuit 224~OOOOO-426102 24.00
._-~
224-00000-426102 55.00
-"--_..
821-00000-215004 9.48
-_. .
100-00000-425605 3.95
TOTAL DUE: 92,43
ljceAYMENTii::lPE,i"~~;-PA"Q.~;' t:"~iCASHIER: L8('-pI>ERY~I&Q~Mj:.Ruj;.0-;i~i:i:'~~; :.",_.,;AMQtilf';;P_~Il2.~;
Credit Card L YNNS ELECTRIC COMPANY $92,43
Branch circuits without service or feeder -1st circuit
State of Ore90n Surcha~ge (12% of applicable fees)
TechnologY,!"e (5% of permit total)
~.,.;:". ~ . :
'~. ""~",,.. .
TOTAL PAID:
$92,43