HomeMy WebLinkAboutPermit Electrical 2011-2-25
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"'Electrical Permit A
225 Fifth Streett Springfield, OR 97477tPH(541)726-3753tFAX(541)726-3689
ii:ji
DEPARTtilENT, USE ONLY'
Date:
This permit is issued under OAR 918-309-0000. Permits are nontransrerable. Permits expire irwork is not started within 180
days of issuance or irwork is suspended for 180 days.
. ,LOCAL. GOVERNMENT.:MPROVAl.
Zoning approval verified? 0 Yes D No
.. CATEGORY,OF.' CONSTRUCTION: '.'
o Residential 0 Government Commercial
'JOB SITE'INFORMATION AND:tOCATION:
Job site address: J I P C? 1-<. kt r
G~ ~h 7
R~ference: Taxlot. \
'". ;.> :f':',.'.~>'~DESCRIPTION,OFcWORK;;J<'."""':~;':;:'" ".'>.
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, :;pROpERTY' OWNER'~
C"o..- VI I-
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, excbange. lease, or rent. OAR
479.540(1) and 479.560(1),
Signature:
. ,'~."(';:';~1,~';iCONTRACTOR~INS:rAIlliATIONr.;i~;':ic~'::;",i;;,';:;J
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
~~.~~
~.
440.2584-1 (9/08/COM)
. :::,:,.>,. '. :',;: ;FEE,SCHEDULE.';' .~. ;. ' ..
." ... -'. :.. <0_"'" ~.. ,- .-', ""':.r" ,,:- ,...., 'Cost " Totil
, N~~I:,~r~~~~~:s.~r(~~~~(:~, Qty, . ':'08::. cost.
Residential, per unit, service iocluded:
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/-.C?-) ,....1... ..L8.M,~~ .L.
rcr.1Tlrnd. f"I...""..... .~
20J to'4oo ~fl.)JW ruies adODl--;' j bv Il$J'9~.p~~ ;1$ iiti!itv
401 to 600 am~(ii)ication Center, -has ) $l5a:oor ) set forti I
60] to 1,000 ~~(~r t;!v.::,-uu [-UU [II UlIl u."" '......r t"?'::4UU I
,D.. v""" ..........", ,.,1.,+..., n "''''' ,1~0~P9h , ~..I~,... 1-... .
Over 1,000 amp'<miY.?!l'! (f)e ~~nter, . . -.- - -
(No e $~~to!!J1 )~lOne
Reconnect only'(lijmber for the. Ore ~on J $li63.00~ ifs:ation
Temporary services or ieea~lis~li,r,ttaiia'i;biCgtle7-;/iig:t.i-~location
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
Il~I'~~~L-
BraDch:cin:uits: n~ alteration, extension per panel .
a. Fee~forbranchl cirCuiiS'Wiih purcliaSe'-oC;a _st~c.e~o~'~~~ fee;
Each t:rim~6,b}~u'iF' J;...~ 11110 r T\IV:II, ..J I'" I $
. $ 6.00
-- -- - .-.- ~ - .- . _ . .....,. .,......... ....,,...,
b. Fee 'for biBiich ~lrC~ii~ w~t1iOut'piirchi:tse'ofa serviCe or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
MisceUaDeous 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 limited-energy panel, I $ 63.00 $b?,()( )
alteration, or extension (2)
Each additional iospection: (I) $58,00 $
~~~'i;$!:,""~~a:fNt. 'W' '''''f~''~!<t;'.i;
_,...,..~~it. ':~ :~,,>li1! ~ -: . CA ci',USE~~",fT*,jY';\;!,f,-.'~.}~'~:,1~j~
(A) Enter subtotal of above fees $ (1 On
(Minimum Permit Fee 558.00)
(B) Enter 12% surcharge (.12 x [A]) $7.St.
(C) Techoology Fee (5% of[AD - . $2. IS
TOTAL rees and surcharges (A through C): q~.7'
(..
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541~726"3753
www.ci.springfield.or.us
811-SPR2011-00307
3100 PIERCE PKWY
pennitcenter@cLspringfield.or.us
RECEIPT NO: 2011000353 RECORD NO: 811-SPR2011-00307 DATE: 02/25/2011
!DESCRIP.TIOril '>'{,.CC,,-'?f!IfJ:,". "~": '''~-,'''";f:rr:':~c~;,:,P.i':}]ACCOUNt:cbDE)'T~+?:L'.7;:;;:;. '.' AM()'U Nftou EL--:......:...iJ
Signal circuit(s) or limited~energy panel, alteration, or extension 224-00000-426102 63.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 7.56
Technology fee (5% of permit total) 100-00000-425605 3.15
TOTAL OUE: 73.71
~'"'PAYME";f)rNP-E",~~\~~RA~Qf{r~'CAS.HIER:':'~M:A'CH;ADo~~;:')k;?,.';'^,,~c6MMEN'-tSi.'::~.L~.~; .~;~:~~a~MOUNT PAID -;";";:":""f ' '.~J
Check SECURECOM INC 73.71
48019
TOTAL PAID:
73.71