HomeMy WebLinkAboutPermit Electrical 2011-5-2
Electrical Permit Application
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225 Fifth SlreeltSpl'"ingfield, OR 97477+PH(S41)726-3753+FAX(541)726-3689
'. DEPARTMENt USE ONLY
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Permit no. 51 ( ~ 0 0 7 Z f,
Date: \~2-( (
SPRINGFIELD
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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.
.' . , c"EOCAVGOVERNMENT"AP.I'J~OVA[3:;':,N;V"~-,Y::
Zoning approval verified? DYes D No
......: -' "CATEGORY"()F:CONSTRUCTION',"" ",'
esidential 0 Government 0 Commercial
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ZIP: ~ )Ca
Job site address:
City:
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Reference:
Taxlo!.:
. DESCRIPTION OF WORK">:C:",':>...,,!':,"''''',-.
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PROPERTY OWNER
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Name:
Address:
City:
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 ren!. OAR
479.540(1) and 479.560(1).
ZIP:
Signature:
CONTRACTOR INSTALLATION
E-mail:
CCB license no.:
Print name of signing supervisor:
Signature of signing supervisor:
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth d
in OAR 952-001-0010 through OAR 952.001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone \\
number for the Oregon Utility Notification. t,>" ~K) ,
Center is 1-800-332-2344). . D~W
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440.2584-J (9/08/COM)
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. . '," ", "", ',' Cost Total'
,Number orinspeetio'ns per item 0 ". Qty. , ,. ea,-, cost
" '. ..."( - - . . ,..;',F :"-.~:', I. , '-':::--""., - .',
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 ..
dwelling service or feeder (2) $ 63.00 $
Services or feeders: installation, alteration, relocation ,.
200 amps or less (2) .t $ 81.00 $ Of
20i to 400 amps (2) $ 95.00 $
401 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) $ 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, alteralion. eXlension per panel
a, Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit 1.) $ 6.00 $~C
b. Fee for 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 ,: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, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees $ (((
(Minimum Permit Fee $58.00) ,
(B) I?~Wll!!.~'i'urcharge (.12 x [A]) $ '3'1' L-
(C) ~~~?80!orn~~n5~Al1])EXPIRE IF THE !No F1\{ -::;5"
TO'F~1~1e~1ii!i![ut.11I@)-g" ~Hl!r~r!'l)T I ~ NC$T \7 '7 ~
7
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
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_&\ OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-00726
1319 M ST
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726-3753
permitcenter@ci,springfield.or.us
RECEIPT NO: 2011000850 RECORD NO: 811-SPR2011-00726
l[)ESCRII~IION' " --- "'., "';: "',-, .- - ;f ',-{:J'. AC.CO:UN'(CODC,;' j - -
Branch circuits with service orfeeder each circuit 224-00000-426102
Services 200 amps or less 224-00000-426102
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
__.!~ch_n_o~g~ f~~ (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: 05/02/2011
L. P.o. YMENT_lYpE
Cash
___P.o. y'OR_ CASH!Eltq"!9J1!.1,SBY _ _ ..:...... "':'C,OMMENTS
I bob fisher electric
0",,"_ .
...._-"---~
~jo:~.; AMOUNT_DUE
30,00
81,00
13,32
5,55
129.87
AMOUNT P...ID _<___
129,87
TOTAL PAID:
129,87