HomeMy WebLinkAboutPermit Electrical 2011-2-22
Electrical Permit Application
225 Fifth Street+Springfield, OR 97477. PH(541)726-3753. FAX(S41)726-3689
'. DEPARTMENT USE ONLY
....;,.
Permit no. 5/1 ~ '2-7lf
Date: 2.- z;z, - ZO If
This permit is issued uuder OAR 918-309-0000. Permits are nontrausferable. Permits expire if work is uot started within 180
days of issuance or if work is suspended for 180 days.
.......LOCJl.l:.c:;OVERNME~T . A~PR0VAL.:.'::.),.;"
Zoning approval verified? 0 Yes 0 No
',iCATEGORY:OFCONSTRlICt!ONU' .'
Name:
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:
CoNTRActoR INSTAllATION
Business name: ;,201::10,',,5 , ,,<-
Address: ? <9. I
City: / d....f jJ, '/1
7'J'S
NOTICE:'" ''''''.
THIS PERMIT SHALL EXPIRE IF THl=~
AUTHORIZED UNDER THIS PERMIT)S
COMMENCED OR IS ABANDONED F
ANY 180 DAY PERIOD.
440-2584-J (9/08/COM)
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. " - '. ,," ".- Cost Total
:Numberofinspe~tio'n!' perife,m ()...,; Qty. .. 'ea; .' cost
".:...,.;,.','.c... ',"_",',;"..,".-,'''-j-:-:' ",'. - '.
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 Jess (2) I $ 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 pane!
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) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump Of 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 of above fees $8\c?
(Minimum Permit Fee $58,00)
(8) Enter 12% surcharge (,12 x [A]) $Y. 1ft
(C) Technology Fee (5% of [A]) ADS
TOTAL fees and surcharges (A through C): $C\~ .:1-
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00274
7024 GLACIER DR
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000321
fDESCRlittI6N~,..,:,.~0 '.~?;?,Cf'" cr. Ji?Ji!::.f,
Services 200 amps or less
State of O:!9on Surcharge (12% of ~,pplicable fees)
Technol99Y fee (5% at permit total)
RECORD NO: 811-SPR2011-00274 DATE: 02/22/2011
'I.' V '\1':: ;.--' , 'ACCOUNLC6DE,,".,:::i:,",::J:5Y;;..:tAIIII6IJN'f:D(JC~"__-3
224-00000-426102 81.00
------
821-00000-215004 9.72
.___w'_"_
100-00000-425605 4.05
TOTAL DUE: 94.77
ft7PAYM'ENJ~TYPE~"+:~,~~~,PAYOR;"vlcASHIER;:BRrCHARDSCrN~: '~i~'*.:1c'OM~ENTS':i'~'~':::-'>&{V~~Zb~0S~~f:rA~OLJNT, pAID r<", ' ~;n'~'":.~t:~" ::::J
Credit Card ROBBINS ELECTRIC INC 94.77
093049
TOTAL PAID:
94.77