HomeMy WebLinkAboutPermit Electrical 2011-1-12
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WiL ,., Permit no.: i-
225 mtb Street.Spdngfield, OR 97477+PH(54I)7~3fOOM!;j4~f~~ law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
This permit is issued under OAR 918-~OO9jicrllllls\l1!t1 \ld~ffllnsfeRiilFe.!'N'r.\lm "expire if work is not started within 180
days of issuance or if work is suspende41iJ'iiillllOOlaysay obtain copies of the rules by
i p. t (0
/LOCAL GOVERNMENT AR f P. Ore n
Zoning approval verified? DYes [g~r is 1-8 0
CATEGORY OF CONSTRUCTION
Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
o Residential 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: q 0
City:
Reference:
E-mail:
This in.stallation is being made on residential or farm property
owned by me or a member of my immediate family. This
proper}y is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLATION
Ie;.. :rr-l
Signing supervisor's license no.:
Print name of signing supervisor: W\
Signature of signing supervisor:
" ~, .'
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE
AUTHORiZED UNDER THIS PERMIT IS N
COMMENCED OR is ABANDONED FOR
A NY 4f~b'Ij5'A<rlfllfflroD.
DEPARTMENT USE ONLY
Date:
p: the telephone
Utility Notification FEE SCHEDULE
- ~-.il~~'\lr inspections per item ( ) Qty. Cost Total
ea. cost
Residential, per unit, service included:
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)
Services or feeders: installation, alteration, relocation
200 amps or less (2) 'l.. $ 81.00 $ \\d2 "
.
20 I to 400 amps (2) $ 95.00 $ ~
40 I to 600 amps (2) I $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 $
40t to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Dr-lOch circuits: new, alteration, extension per panel
a Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $6.001$
b. Fee for branch circuits without purchase of a service or teeder fee:
First branch circuit (2) $ 55.00 $ c)
Each additional branch circuit .~ $ 6.00 $t~C
.
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 Iimited-energy panel,. $ 63.00 $
aJteratio~ or extension (2)
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ 1)/1 :)
(Minimnm Permit .'ee $58.00) r ""'). 0
(B) Enter 12% surcharge (.12 x [A]) ~ \,,1,'::1
(C) Technology Fee (5% of[A]) $ ,o."'-c b
TOTAL fees and snrcharges (A through C): $ Il:(.~
v r
SPRI1.N ':-..FIE?ij
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''';1!F:i: I/!1i
;.l7,k~~ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth $t
Springfield,OR 97477
541-726.3753
www.ci.springfield.or.us
811-SPR2010-00170
790 30TH ST
permitcenter@ci,springfield.or.U5
RECEIPT NO: 2011000085 RECORD NO: 811-SPR2010-00170 DATE: 01/11/2011
[bESCRI~TION . \i "'I' ,.::;- ,~"fG.~f ~,.;;~,;_~;:,.. )'~;;','i;,~;;c";;ii~' "'iJACCOtlNTZC.0DEs:,'c;'i, or':"';' ~., ~" "AnilOU'NLDU EC:.: - .- "~I
Branch circuits with service or feeder each circuit 224~OOOOO-426102 18.00
Services 200 amps or less 224-00000-426102 162.00
Se'rvices 401 to 600 amps 224-00000-426102 158.00
----2t!!!e 01 Oregon Surcharge (12% 01 applicable f~~'1....__ 821-00000-215004 40.56
__..:r~chnology le~J.?% ~permit total) 100-00000-425605 16.9D_..._
TOTAL DUE: 395.46
::..:~XMg~IJ),e.E';...=.:....R8.Y.QR:-:; . Eflj~~HfER::LEQPj>ER Co',;.i..-' t:-OMMENitSi~;?;{.--,_:':~~:i:::i::':; '._ .~I'v1()UNtI>,AID:::_';c_L.:.o,_\,;:. 1
Credit Card gmd electric $395.46
045699
TOTAL PAID:
$395.46