HomeMy WebLinkAboutPermit Electrical 2011-1-21
225 Fifth Street+Springfield, OR 97477.PH(541)726~3753.FAX(S41)726-3689
":,1 . DEPARTMENT USE ONt. Y
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Permit no,:
Date: 1- 2/-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 suspended for 180 days.
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Zoning approval verified? 0 Yes 0 No
;CATEGORyjiO";:CONSTRuctfoN\';'X' '. ,
D Residential D Government Commercial
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F,~ I State: oIL ZIP:" '7t{73
7c) "s I..( Taxlot. 0 "J 10 I
. .DESCRIPTION OF'WORK";"';'J~'\:'"
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'PROPERTY OWNER
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Name:
m.e
S::-7o
,'- '::> ~A
~r(-'",
Address:
City:
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 479.560(1).
Signature:
Address:
City: C<.
Phone: '
E-mail:
IL
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BCD license no.: 2-V- 38
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Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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.' ........ '.,'. '" -,., Cost . Total
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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 $
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) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to ] .000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: instalLafion, alteration, relocation
200 amps or less (2) $ 63.00 $
20] to 400 amps (2) $ 87.00 $
40] 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) I $ 55.00 $:>S
Each additional branch circuit It $ 6.00 $ zA"
Miscellaneous fees: service or feeder 'Yo! included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 53,00 $
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 of above fees
(Minimum Permit Fee $58.00) $ 71,
06
~11jIill:~nter 12% surcharge (, 12 ~'[;\]j"""'i' - q .lj~
.. $
c 'PPR~R'I'V~t~;:J=ljI1iJ\f~~~~ . $ 3.C't.5
'''OO1MlfUW~~):'' $C)d.Y3
o OR I::; r'_
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-001-001 0 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notiiication
Center is 1-800-332-2344).
tfi
~ NO
. \Jv THI
AUT
COMMENCE
ANY 180 DAY PERIOD.
440-2584-J (9/08/COM)
- ,_ 'AI
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00100
5701 MAIN ST
permitcenler@cLspringfield.or.us
RECEIPT NO: 2011000140 RECORD NO: 811-SPR2011-00100 DATE: 01/21/2011
lDESGRIF'TION"':':,:,:,;,~..,,,:. ~:::'S~17" .'; ":';c::J,:C.1Z::"c '::,:!~L:<\CC0LJNtCODEl;":"",!:~"-:Js;6,,,:.o:MOUNT.D(jE::': > ' '. :~
Branch circuits with service or feeder each circuit 224-00000-426102 24.00
. .~.~._. ______ _ .___,__ _~__.___,__.. _'.'W'_ ..,_._.._~ __,~_._.. .. ..~.. __.~~___.____ _ _______ _. _ _ _____ _ _ .__
Branch circuits without service or feeder -1st circuit 224~00000-426102 55.00
__..__'._____u..___________ .~_..'"___.____,____~~.___._.. __ _ _.__._ ___ _______.. _ .
State of Oregon SurEharge (:12% of applic~~I:.fees) ___ 821:E9.~00:..~12.?_04___.__ 'n'_" ~~8_.._ _ _
TeChnology fee (5% of permit total) 100-00000-425605 3.95
TOTAL DUE: 92.43
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Check pioneer electrical contrcting inc $92.43
3157
TOTAL PAID:
$92.43