HomeMy WebLinkAboutPermit Electrical 2011-3-25
"', _ .:i
EIlctrical Permit Application
t
225 Firth Stree,.Springfield, OR 97477tPH(541}726-375HFAX(541)726-3689
DEPARTMENT USE ONLY
//-:-S?'~// - 9<2'-1
Perrmt no.:
Date:3/2S) 26/
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.
" . 'l:bCAL'.GOVERNMENTAJ:)J:)ROVAC',c;,"
Zoning approval verified? DYes D No
\ ,. . ....,"CATEGORY.;bFCONSTRUCTION:.
~, 'CO:',.'_
o Residential.
~~i;ifr,~JOB;SlmE
Job site address:
City:
Name:
Address:
City:
Phone:
E-mail:
This installation is being made on residential or fann 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).
State:
ZIP:
Fax:
Signature:'
Business name:
City:
Phone:
E-mail:
CCB license no.: f
Signing supervisor's license no.:
Print name of signing supervisor:
~ ..
foilow rules adopted uy the Oregon Utility
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952:001-
0090. You may obtain copies of the rules by
calling the oenter. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-3322344).
~\'\
~11i""
11 0--\.
.I-ri"~rr-.
. _ 1 ~ .J_..
~"~~~{"":;~:',;~':(K';,~~:~~~~7#~r~:?;T~:I5EE{~,SCH EJ).lJJjE~l:-'~';l$,(Y;;fP;;~:-7~4{mi:!~~~!~~Ii~R~
, . . -" ,',' Qty. Cost Total
N~Iri"~.er' ?.f.:i~s~ect~o'ns p~F,ite.~,"(,) .~ .... ea,'. 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 feed~r (2)
Services or feeders: instal/ation, 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 $
40 I 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 ~ervice or fe"eder'fee;
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $ ?
Miscerlaneous fees: service or feeder ':lot 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 aaditional inspection: (1) $58.00 $
~~}:~~i~~@i~~\Wl~t~~Y{J~:~~tA'ftefIcA:Nr{{U$Ek~,j,JJ:'":.~~~;H;ik;V;'l~~;i!;:,:i;;})L;\:',/~,: 0
(A) Enter subtotal of above fees tJ[ <>
(Minimum Permit Fee $58.00) $
"
(B) Enter 12% surcharge (.12 x [A]) /$ .AJ. I
J!~)rJ;e,e,pp?locglj,F,f5L50(tOf.l.y)\MnQv. / $ LT
:iO:TACfee'S:.'nii s;:'~~ha~ges,(A\,hrough C):l $ 1/) /_
- JIll'" ,,...,... 'ML..... ...-,'-',," . I. I V I .
ED OR IS ABANDONED FOR '----- .
2-""
Stj
~
440-2584-J (9/G8/COM)
ii'S PER~
,UTHORIZ
COfv1MENC
ANY 180 DAY PERiOD.
r...
..
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00489
4266 JASPER RD
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000551 RECORO NO: 811-SPR2011-00489 DATE: 03/25/2011
lbES'CRIe.tiOW)"-;'~ ,- "". r;i4\;L.J"f\1:C~ -'>.-'cz'.-f);.itf),.".,.7.f' f/?c.C.6.UNT_C.ODEt>;;t:.~fi( " ~/?N1O:0NtDlJE . . "
Branch circuits without service or feeder - 1st circuit 224-00000-426102 55.00
Branch circuits without service or feeder - each additional 224-00000-426102 36,00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 10.92
Technology fee (5% of permit total) 100-00000-425605 4.55
TOTAL DUE: 106.47
>.,:-:!.C.Q~Mg~IS;':c';.;/.;_.;,-.~;.. 'J,iA~OUNT.PAID:. .... ----'.J
106.47
Lsr"-~YM:Ei:lI..L'r'I'!;";f;"'-;P...A..):QR~SHIER-:'NMACHA'DO\';;
Credit Card Grizzly Electric
833938
TOTAL PAID:
106.47