HomeMy WebLinkAboutPermit Electrical 2011-3-29
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225 Firth Strcct.Springficld, OR 97471+PH(S41)726-3753.FAX(541)726-3689
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, DEPARTMENT USE ONLY
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Penmt no.:
Date:
c2 /.z-9 /I(
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.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? D Yes D No
CATEGORY OF CONSTRUCTION
Residential D Government D Commercial
JOB SITE INFORMATION AND LOCATION
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Name:
Addres.
C
Phon
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).
Signature:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor
44o.2584-J (9/08/COM)
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FEE SCHEDULE
Number of inspcction~ pe~ item ( ) , Qty. Cost Total
ea. cost
Residel1tial. per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. Of portion $ 2s,oO $
thereof
Limited energy (2) $ 32.00 $
Each manufactured home Of modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
20 I to 400 amps (2) $ 95.00 $
40 I 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 $ h~
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
20] to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps Of 1,000 volt'), see services Of feeders section above
Branch circuits: new, alreration, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 $
b. Fee fOf 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 1I0r 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: (I) $58.00 $
- . AP~L1CANT USE
(A) Enter subtotal of above fees $ ~2 fP
(Minimum Permit Fee $58.00) .
(B) Enter 12% surcharge (.12 x [A]) $ 3.
(C) Technology Fee (5% or [AJ) $ 7.-,<; 7~
TOTAL rees and surcharges (A through C): $ 7-.5' I
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"L........ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541-726-3753
www.cLspringfield,or,u$
811-SPR2011-00203
2763 21 ST ST
permitcenter@cLspringfield,or.us
RECEIPT NO: 2011000573
115i:sc RII~.TIONl,,,. '''';'''' N.,j'.:":.i[~f
Service reconnect only
State."f Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-00203
DATE: 03/29/2011
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224-00000-426102 63.00
821-00000-215004 7.56
100-00000-425605 3.15
TOTAL DUE: 73.71
tiPAYMENTi1Y~]t'~, '-(.'~Ayo~'"i:7icASHIER'?NM1CHADcr:~~~~'?W;~~~'~'C'()MMEN-TSjJ':~,\ :%1+r~]ff&f;;i:';2':: ,'" ;s;:;;gAMOJJNT~P AlP: :::;~::'~/
Credit Card CROW VALLEY ELECTRIC/MAG 73.71 .
237605 ELECTRIC
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TOTAL PAID:
73.71