HomeMy WebLinkAboutPermit Electrical 2011-1-19
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J Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726-3689
DEPARTMENT USE ONLY
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Date:
Permit no.:
. This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire jfwork is not started within 180
days ofissnance or if work is suspended for 180 days.
,. ~. subtotal of abovefees
~ll~rl~EE~MIT SHALL EXPIRE IF THE WO~RK ~$' n urn Permit Fee $58.00)
\UTHORIZED UNDER THIS PERMIT IS NOT _V1-st ~ r 12% surcharge (.12 x [A])
C;Oil~MENCED OR IS ABANDONED FOR -,. \. ~\jv b~ logy Fee (5% of [A])
,\NY i 80 DAY PERIOD. ~~fi ~. ."~~~ ~fee,;d surcharges (A through C):
440-25&4-1 (9/08/COM) <q oN ~
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LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
D Residential D Government D Commercial
JOB SITE INFORMATION AND LOCATION
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Phone:
E-mail:
This installation is being made on residential or fann 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 479.560(1).
Signature:
CONTRACTOR INSTALLATION
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ZIP,c17 <I 0 I
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BCD license no.: ;)O-5~ 1C-
Signing supervisor's license no.: c....( ,?,l.f
Print name of signing supervisor: IVtt elf . (Pow! I.!
Signature of signing supervisor:
Number of inspections per item ()
Total
cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63.00 $
Residential, per unit, service included:
1,000 sq. ft. or less (4)
Each additional 500 sq. ft. or portion
thereof
Limited energy (2)
Each manufactured home or modular
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 $
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 $
201 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 branch circuits with purchase of a 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
rP
$
:tr.
.
.
TRANSACTION RECEIPT
811-SPR2010-00726
4824 HIGH BANKS RD
www.ci.springfield.or.us
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726~3753
RECEIPT NO: 2011000118
RECORD NO: 811-SPR2010-00726
permitcenter@ci.springfield.or,us
~bESC Rf~tI6N"; ::':~'<"J;:7~:'".;~1~,'~'i~;;".tJ::'~~~)Li:0; ',2 '~;, _~', :c:;;i'pJ>~~~~~~,:; ';~Acc:(iONj.lC_b[)E~iWt'"o i' .:t~,~;;,~;
Branch circuits with service or feeder each circuit 224-00000-426102
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology fee (5% of permit total) 100-00000-425605
TOTAL DUE:
"~~'.' ~. .... . ." ....'C''fi':.....-.....'''...:..., "..,--.,,-,.,,-, .' '" .l. .' ,.' ......- ~ ~ ",-..c," --'... " 'A'-"'; "j.",J> %F:.' - ,~.~ ...---"..~-m:., ~..,. ~':,..C.-:':..:',
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L::F'A YMENT TYP!;__,:;:C- E~YORY;;-- ~_tpASHIER: '!'!'~~E2:,,"~,,--C_OMMENIS ::7,n-:l;';l;;.-!c~..;::-,
Credit Card GMD ELECTRIC/MICHAEL K.
GOWINGS
079934
TOTAL PAID:
DATE: 01/19/2011
: 'if-'AMOUNTcDlIE-':')':"i,,_'d
, 108.00
12.96
5.40
126.36
. AMOUNT,PAID': :;.~.;. 'W
$126.36
$126.36