HomeMy WebLinkAboutPermit Electrical 2011-4-8
225 Fifth St"e.tSpringfield, OR 97477tPH(541)726-3753+ FAX(541)726-3689
DEPARTMENT USE ONLY
~ ZO(/~OO 57z..
Penmt no.:
Date: l.{
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. .
" . "tOCAL;. GO\lERNMENTAI'PROVAL',,:.l:"/' ", i
Zoning approval verified? DYes DNa
d:~, "c').CATEGORY'Ot=:CONSTRlJCTION:* /. .
Name:
Address:
City: c;;:
Phone: S'l
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:
. CONTRACTOR INSTALLATION
'JI<?~~' 'C:L~/C
Address: . 50 LI '-I
City: 6 State,p~ ZIP9?4C?
Phone:
E-mail:
CCB license no.:
BCD license no.:
Signing supervisor's license no.: "?<Or? S
Print name of signing supervisor: "'Roe --rtt",lI' ~w
Signature of signing supervisor'
ATTENTION: Oregon law requir S you io
follow rules adopted by 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 center. (Nole: the telephone
number for the Oregon Utility Notification.
Center is 1-800-332-2344).
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440-2584-J (9108/COM)
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,N~~~"er' o.f)nspe~t~o'~~ per.lt~.~,'~.) Qty. Cost Total
- - - - ,c.- -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 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 $
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) ( $ 55.00 $'7'> -
Each additional branch circuit $ 6.00 $
Miscellaneous fees: service or feeder ,:ot included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal ci"rcuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each aC:lditional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees
Ill(Minlmum Permit Fee $58.00) $ s&?
1 . II ~, ;':..'
110il1Ijn~rnf.'lrs3'ffi~.$.<' Bf.'l\n1llIF THE WaR , $ b 7' :>
II(C)~tecnb.9[0ID-lF~KI~i,1\071[{1:D PERMIT IS NO $ Zli" ~
( ("""'~~lnUhIi1D '" 'n^"IQAlt'rlilirhlB $67>' .0
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00572
201 5 18TH ST
CITY OF SPRINGFIELD
225 Fifth $1
Springfield,OR 97477
541-726-3753
permitcenter@ci.springfield.or.u5
RECEIPT NO: 2011000686 RECORD NO: 811-SPR2011-00572 DATE: 04/08/2011
[ri,ESCRIBTION' '0 ;~"i; '.ll.4 ,.;>;;,,'s';" '~;"~;;.:;',;"Ir,'*':'i;1~.jj;;"ACc0XjNT~c6DE;:'1 ';Z.'";_l;~Tt." AM6uN:r~DUE"";'.\.;{1
Balance of Minimum Electrical Permit Fees 224-00000-426102 3.00
Branch circuits without service or feeder ~ 1st circuit 224-00000-426102 55.00
821-00000.215004 6.96
100-00000-425605 2.90
TOTAL DUE: 67.86
--':~'~"~t=:~~~;:}~:\~; ;~MOUNTPAID.:. ^" .i, I
-..---", - ..~
_~~..2r:;90n Surcharge (12% of applicable fees)
.-2echnology fee (5% of permit total)
t.e~'y]JiE~T.:.rYP,E,,: ",' ''::e)>.Y.QR '\~c'A;iHiER"oBOWLSBy;;::.\',::-::;:!;ic_QMNi~N:ts ',;'.:
Credit Card THORNTON ELECTRIC INC
218085
67.86
TOTAL PAID:
67,86