HomeMy WebLinkAboutPermit Electrical 2011-4-14
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Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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I Permit no.:
Date: L(-Il.{-f f .
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.
Signal circuit or a limited~energy panel,
alteration, or extension (2)
Each additional inspection: (1) $58.00
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Notification Center. Those rules are set forth (A) Enter subtotal ofabove fees
in OAR 952-001-0010 through'OAR 952-001- (Minimum Permit Fee $58.00). .
0090. You may obtain copies of the rules by
calling the center, (Note: the telephone N 01 !~);~nter 12% surcharge (.12 x [AD .' .
number for the. Oregon Utility Notification THIS 1(?);:,T[f,fl'l'Q.\~~ffe(-5~p.l\[A THE WORK
Center IS 1-800-332-2344).,,{) (\AUTIIG'/'?I!'Nl ~~~~!'.~:s\'rfl!J1~g~'R(~;tJi~Q)Ig!t'):l);
~e?::\..~COMMENCED OR IS ABANDONED FOR
t><.:~x! ANY 180 DAY PERIOD.
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Zoning approval verified? 0 Yes 0 No
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o Residential ,overnment 0 Commercial
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lob site address: ZZ-'5 <;+1- S
City: c:;:pp-p State: Q(L 7l{7
Subdivision: Lot no.:
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Name: Cr.f.. G ~ It,,,- ,.,.1
Address: Z <) S+l- S 1-
City: S f 0. Stated- 7'f77
Phone:')t{{-- -37::> Fax:
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:
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Business name: E~ ,f7!2Ic!. L-L c:
Address:
Signing supervisor's license no.:
Print name of signing supe~visor:
Signature of signing supervisor:
440-2584-J (9/08/COM)
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 TI>
Each manufactured home or 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 $
60 I to 1,000 amps (2) $205.00 $
Over.l ,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
201 to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ 87.00 $
$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 ofa service or feeder fee:
Each branch circuit
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
I
$ S S-
$
$ 55.00
$ 6.00
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
$ 63.00
$ 63.00
$
$
$
$
$ 63.00
) 'is' $
$
$
$
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. 3"',-\ OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00580
225 5TH ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permilcenler@ci.springfield.or.us
RECEIPT NO: 2011000718
[DESCRf~TI(jN " . " -
Balance of Minimum Electrical Permit Fees
RECORD NO: 811-SPR2011-00580
DATE: 04/14/2011
Branch circuits without service or feeder. 1 st circuit
ACCOUNT_CODE
224-00000-426102
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
'AMOUNT_DUE
3.00
55.00
6.96
....-------.------- .-
2.90
---_...._-~--_._--
67.86
AMOUNTPAID
67.86
I
_~_tate of Oregon S~rcharge (12% of applicable fe~l
Technol09Y fee (5% of permit total)
UP.I'.:V:I'!I"!HlfyEE'~' "'-.p"~jOR CASHIER: OBOWLSBY .-
Internal Transfer city of springfield
. ~- CQM"ME~IS.
bill internal charges to
420-62224-810050
TOTAL PAID:
67.86
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:i.-< '-OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-5PR2011-00580
225 5TH 5T
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541~726-3753
perm itcenler@ci.springfield.or,us
G..~'\\XNlE.NTJX~~ ',;< p.Aygir'C'cAsHIER:DBOWtSBV)
Internal Transfer city of springfield
RECEIPT NO: 2011000718 RECORD NO: 811-SPR2011-00580 DATE: 04/14/2011
tbESCRI~TION: ;v,;" '" "~"7-",;E,~j&_$'0~_" ""'i:,fFt~~;? !~ACC()UNf~c.()[)E -,~.'-' ~~~~;'f'(>'M0UNT.D,UE ;','C.:J
Balance of Minimum Electrical Permit Fees 224-00000-426102 3.00
Branch circuits without service or feeder - 1 st circuit 224-00000-426102 55.00
--
._... Stat':. of Oregon Surcharge (12% of applicable fe".s) 821.00000.215004 6.96
_ _T~chn91.ogLf~~j5% of permit total). ___ ~~___10~,;~000~;425605 2.9~__
TOTAL DUE: 67.86
'}-~~~1:t'Z.cQMM_e.Nis'~;J~:,?';';~';_::: "~;r:i%~;.,:,jp 'i,~ _ t~M01JNI:P AID . ~,<,':'-~-': ' ~:~:~""i
billlntemal charges to 67.86
420-62224-810050
TOTAL PAID:
67.86
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