HomeMy WebLinkAboutPermit Electrical 2011-3-8
Electrical Permit Application
I <<mri'f <IDW ~~m~ <IDIm@<ID~
225 Fifth StreettSpringfitld, OR 97477tPH(54I)726-3753tFAX(541)726-3689
I~
DEPARTMENT USE ONLY
Permit no.; 5/1- (!) 0 3t1b
Date: 3-<15 -z.,eJ/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.
ZIP: 'fSJO(
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
Print name of signing supervisor:
Signature of signing supervisor:
~~ \^'.\\
~'~
1~
440-2584-) (9/08/COM)
FEE SCHEDULE
Number of inspections per item (,) Qty. Cost Total
... cost
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)
Senrices 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 $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) I $ 55.00 $ 5'5;
Each additional branch circuit It $ 6.00 $ ;yt~ ~
Miscellaneous 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, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $ 7q~ y-
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A]) $ Ig'ffi-
(C) Technology Fee (5%0f[A]) $ 7Cj$
TOTAL. rees and surcbarges (A through C): $ lfrl( l' b
Glwfv'u.< 15...uI.{' vJlo fltv...,t? If{Cj g..
"'j
(t11c1cdd. i.. ,',,)
'\.+Cf..1!.- Fee.- /
S.P~I~. ~ FIEL~
~:I'.,.
'~';~' arv
""~:'~ OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00346
5707 MAIN ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
permitcenler@ci.springfield:or,us
RECORD NO: 811-SPR2011-00346 DATE: 03/08/2011
" "- ,. ,,,"CC()UNt.:.C()DE"'C.::t;::;"'ti~;;AM()UNJ_DlJE';', . .; j
224-00000-426102 24.00
224-00000.426102 55.00
224-00000.426102 79.00
621-00000-215004 16.96
100-00000-425605 7.90
TOTAL DUE: 184.86
!:':2lfl'.yMENT.rX~E:.' .::~I'.XO~~::"'''~~HIER'.BRICHARD~~;;;'S,-,,:1;~c.()MriiE:~fs:: ..?'~,"i~'" . ,.' 'i-' AMjlUNT PAIO:'_, ",'" v - ':]
Credit Card BHM ELECTRIC COMPANY 184.86
472884
RECEIPT NO: 2011000417
IDESCRiP"TION ,-'. ~:;w:'" ;",,-, 'A. ,;" -ic'~:'" '
Branch circuits with service or feeder each circuit
Branch circuits without service or feeder - 1 st circuit
Building Without Electrical Permit Penalty
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
TOTAL PAID:
184_86