HomeMy WebLinkAboutPermit Electrical 2011-4-21
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Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477. PH(S41)726-37S3' FAX(S41)726-3689
tiE~,6.RTMENT USE ONLY
~r!n':<20 580
Dale:
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This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire jfwork is not started within 180
days of issuance or if work is suspended for 180 days.
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Eaci,...~~i '(!i\ I inspection: (I) $58.00 $
ATTENTION: Oregon law requires you to . ?II'-\:j;v. ~_;.:;;~;t~.:;,t21~lA~e)jT~JfNT~'(.J$E\';;':;.;:t)Y&'.'i/:.}.:~:
foilow rules adopted by the oreg~I!I~If}C.. sW'\.\.. \:'f. S ('i\~j\ tr)\\ubtollilofabov;,fees $
Notification Center. Those rules are~~W.o~\lI'-~I"'i \)\'\D\:I'- "'i\-\I ~ ~tW1llJilJm Permit Fee $58.00)
in OAR 952-001.0010 through OAR ~~(\l,q(ii'\ll\:D 01'- IS ",,,IX . (B) Enter 12% surcharge (.12 x [AD
0090. You may obtam caples of the "tllesl1l)'t.~c,t.D IClD.
calling the center. (Note: the teleptt6rl~l'1\ D '\'1 ?\:I'- (C) Technology Fee (5% of [AlJ
U'I't N t'f' t.... ~\\G 1" rt \
number for the Oregon tll Y 0 I Ic~)p.n ':\JV \ TOTAL fees and surcharges (A through C):
Center is 1-800-332-2344). ~ {'-'
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. ) '.', .' 'COC,6.L'GO\lERNMENTAt'if>ROVAC,;/"i
Zoning approval verified? DYes D No
. '. '. ".C,6.TEGORY/bI'CONSTRUCTION'," '.'
o Residential ovemment 0 Commercial
~<1::~1'';)';JOI3R$rI1EYINI'ORMAjr:lON'AN[j\:I1()tAf:ION)~1i~i~Xi'
] ob site address: Z Z c;-. S T S
City: 5"?r~ ZtP:Jt-m
Reference: \703>53 Ta~lol.:03~OO
'DESCRIPTION, OF WORK
LOW Vl}( fdt- L
Name:
Address:
'71{
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 renl. OAR
479.540(1) and 479.560(1).
Signature:
City:
Phone:
E-mail:
CCB license no.:
BCD license no.:
.c
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-J (9/08/COM)
/:!"';-':'<:\~f:<;,~r#7:~i~pm~~;~.~:~t;~,FEE~,SCfl E_D.U IllEf.;{;;tf{~~(~//~H~::~;r~~~-W:1.~~~-
. . .'. .. . Cost. Total
,N~ni~er' ~J:jnsp, e.ctions p~r)te.~' 0 . . . t
. _ ',"' '. .' :. "ea.", ' ,cos
Residential, per unit, service included:
1,000 sq, ft. or less (4) $134.00 $
Each additional SOO'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 Dr 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 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)
201 to 400 amps (2)
40 I 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 perpanel
a Fee for branch circuits with pur~hase of a 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
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder ':lot included
Each pump or irrigation circle (2)
$ 63.00
$
$
$ 63.00
$ 63.00
$6~
$ 7zb
$ -O'C:l
$ ,..I:)
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00580
225 5TH ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permitcenler@cLspringfield.or.us
RECEIPT NO: 2011000777 RECORD NO: 811-SPR2011-00580 DATE: 04/21/2011
lDESCRIe.TIONc_~' .'T'~:,"-:d:.:::....:L '~-/:';:?;.::;:t;;; .;'~'::-,:':":ACCOUNT:CODE: ..: ~/-\;:'-";'-AMOUNtDUE:"_':"-.. _~:.J
Signal circuit(s) or limited-energy panel, alteration, or extension 224-00000A26102 60.00
- -- -- -^- ---,'~-------,-----<' <--'-"'-""'- -_...'---------'-_.__._-~----- ~
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 ~_____..2:2~__ _
Technology fee (5% of permit total) 100-00000-425605 3.00
TOTAL DUE: 70.20
Y"PAYM5t:!T:;TYPf', :-:t:,jPAyoR'TcASHiER- D'BOW~y~1y:;:::-':.t'\:C_OMi\'IENTS)/:-,:';..";\" '-; '" . AII'I9Ui'iTPAIQl ";';':f~
Internal Transfer City of springfield bill internal charges to 70.20
420-62224-810050
TOTAL PAID:
70,20