HomeMy WebLinkAboutPermit Electrical 2011-4-21
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Electrical Permit Application
CIT\tOF:SPillNGFIELD~' OREGON" .
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225 Fifth Street. Springfield, OR 97477.PH(541)726-3753tFAX(541)726-3689
DEPARTMENT USE ONLY
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Permit no.:
Date: -Z(- t (
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.
ATTENTION: Oregon law requires you to
fo".~w r~les adopted by the Oregon Utility
!'lotlflcatlon Center. Those rules are set forth
In OAR 952-001-0010 through OAR 952-001-
0090.. You may obtain copies of the rules b
calling the center. (Note: the telephone y NOTICE:
number for the. Oregon Utility Notification THIS PERMIT SH
Center IS 1-800-332-2344) A .
. UTHORIZED UN
COMMENCED OR
ANY 180 DAY PERIOD.
LOCAL'GOVERNMENT APPROVAL'
Zoning approval verified? 0 Yes 0 No
, 'C,6.TEGORycOF.CONSTRUCflON'<,"
D Residential D Government ommereial
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Job site address:. 5707 I-'YIftlN s T
~ S~~ ~ ~'~8
Reference: 1"702 ~'3 '1'f Taxlo!.: 008'0'0
DESCRIPTION OF WORK".......d.. .
Dh CI t-c.tA, ,-
PROPERTY OWNER
Name: Wl'fCa.tve- C".>SS'.
Address:Z15/( C 'S.T 5 Ie
City: ev-lrt. State: C A
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).
s:. II
1S:
ZIP: ?S5;'O (
Signature:
'1./ 'i
041/ C-
440-2584-J (9/08/COM)
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,Num~er. o(.inspecti(lris p~ritein.'C) -. Cost Totar
. ,,'.' . .,;. ,.. Qty. i .e;J. 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) S 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 $
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 S
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 S
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 ofa service or feeder fee;
First branch Circuit (2) / $ 55.00 $S-S-
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 circuit or a limited-energy panel, S 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
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(A) Enter subtotal of above fees $ S-g-
(Minimum Permit F(e'$58.0ii))
(B) Enter 12%silreharge (.12 x [AD $ , fr,
1m li'effihlliOgf Fllrl~o,WB 00) $ 2 yo
I.",,,, " u~h~lg~s (A through C): $ b 78'f>
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TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth SI
Springfield,OR 97477
541-726-3753
www.cLspringfield.or.us
811-SPR2011-00657
5707 MAIN ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000772 RECORD NO: 811.SPR2011.00657 DATE: 04/21/2011
lDESCRIF1.T[ON"- "';:4"';,:~,"i;,.:: -:':;.~ ')k:i!~~ J!,'II,cAcCC)(JNLCODE",',;;':;:l'.."", : .'ANiOUNT=DUE
Balance of Minimum Electrical Permit Fees 224-00000M426102 3.00
Branch circuits without service or feeder -1st circuit 224-00000-426102 55.00
State of Oregon Surcharge (12% of applicable fees) 821.00000-215004 6.96
Technology fee (5% of permit total) 100-00000-425605 .'__.' ~_2JlO_~
TOTAL DUE: 67.86
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67.86
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Credit Card everyday electrical
003341
TOTAL PAID:
67.86