HomeMy WebLinkAboutPermit Electrical 2011-3-1
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/Electrical Permit Application
CITY OF SPRINGFIELD, OREGON
225 Fifth Streett Springfield, OR 97477.PH(541)726-3753.FAX(541)126~3689
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DEPARTMENT USE ONLY
I
Date:
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.
NonCE
THIS PEP
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
lOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government Commercial
JOB SITE INFORMATION AND lOCATION
"-C Ie
Name:
Address:
City:ec
Phone:
E-mail:
This installation is being made on residential or fann property
owned by me or a member afmy immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560( I).
Signature:
CONTRACTOR INSTALLATION
E-ma".
Business nameS'
Address:
.'-
Cny: r
Phone.
CCB license no.: ~
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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 Notification
Center is 1-800-332-2344).
440.2584.J (9/08/COM)
.~
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per unit, service included:
1,000 sq. It. 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 $
d\yelling seryice or f~~d_~J (2t -. -
Services or feeders: instal/ation, alteration. relocation
200 amps or Jess (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
60 I 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 $
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. Fce 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 $
E~ch additicnal branch circuit $ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2) ~O- 'li
Each sign or outline lighting (2) /) $ 63.00 ~/'3
Signal circuit or a limited-energy panel, \ ../" $
alteration, or extension (2) -,-...00
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees b3
(Minimum Permit Fee $58.00) $
(B) Enter 12% surcharge (.12 x r A]) $ 7::'0 ""
(C)Technology Fee (5% of [A])" $ 'JIS '"
~nlTrAIAees and:s1lrt:hjfr~}1€:\ \fIitdiig~ C): $ <"J .,
1 ~IlJ-o.I' 'I II 1L.. . .. .' -.
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/~$ 73
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= . OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
www.cLspringfield.or.us
811-SPR2011-00291
1922 Marcola RD
permitce nter@ci.springfield.or.us
RECEIPT NO: 2011000369 RECORD NO: 811-SPR2011-00291
IOESCR!PJ'ION:;S" .,' ~'.F.~"; "",,0; ;w:L~~i;,; ~..;\l"0?r;:;l:Z;_':..",l\CC6uN:rcC.OtlE:~.L"
__:-;i9n or outline 1i9hting 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:
..PAydRr,~'CASHIER:nBbWLSBY~./ ,:".;~fz:~: G9MME'~i~~t~; '\;.
Signcraft electrical advertising lie
DATE: 03/01/2011
, ''''l\'f1\N10UNI.i:>UE_.''::~:.J
63.00
7.56
3.15
73.71
, AMOUli'!/PAIQ ,1
73.71
~AYIlliENif-fYPE:
Check
1453
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TOTAL PAID:
73.71