HomeMy WebLinkAboutPermit Electrical 2011-5-2
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Electrical Permit Application
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22S Fifth Street .Springfield, OR 97477. PH(541)726.3753. FAX(S41)726-3689
~PFlINGI'IIZLD
DEPARTMENT USE ONLY
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Permit no.:
~,
Date:
This permit is issued under OAR 918~309-0000. Permits lll'C nontransferable. Permits expire ifworf{ is not started within 180
days of issuance or if work is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
D Residential 0 Government IZJ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 162 S 15 th
ZIP: 97477
Subdivision:
Service
Name:
Cily:
y- S;l
ZIP:
Phone:
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate fomily, This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signahlre:
CONTRACTOR INSTALLATION
Business name: Olsson Industrial Electric
Address: 1919 Laura Street
City: Springfield
Phone:541 747 8460
ZIP: 97477
747 4846
E-mail:
CCB license no.: 63473
BCD license no.: 20 - 2 41 C
Signing supervisor's license no.: 3334 S
Print name of signing supervisor: Doug
S~gnaturc of signing supervisor:
^'TTENTION' Oregon law requires you.t.o .
" . b the Oregon Utility
follow rules adopted Ye rules are set forth
Notification Center. ThhOS hOAR 952-001-
. OAR 952-001-0010 t roug JJ
In btain copies of the rules by
0090. You may 0 Note' the telephone
calling the center. ( '.. N tification \
440r\tJl~,-Iti'l!q81<:li'>.l\1e Oregon Utility 0 .\"..'1
Center is 1_800-332-2344). ~~\Y
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FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
ea. cost
Residential, per uuit, service included:
1,000 sq. ft, or less (4) $134.00 $
Each additional 500 sq. ft. 01' portion $ 25.00 $
thereof
Limited energy (2) $ 32.00 $
Each manufnctured home or modular S 63.00 $
dwelling service or feeder (2)
Services 0" feeders: ills/ollalioil, ollc/'{//I'OIl, reloC(/tioll
200 amps or less (2) 1 $ 81.00 $ 81
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 2,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary sci"viccs 01' fcce]crs: installalion, allemtioll, relocatioll
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 cil'cuits: ne\l\ altem/ion, exfellsioll per pallel
a. Fee for branch circuits with purchase of a service or feeder fee:
Ench bnmch circuit 7 $ 6.00 $ 42
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) $ 55.00 $
Each additional branch circuit I $ 6.00 $
MiscellaneOllS fees: service orfeerler not il/clllded
Each pump or inigation 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: (I) $58.00 $
APPLICANT USE
(A) En(crsublotal of above fees $
(Minimum Permit Fce $58.00) 123
(B) Enler 12% surcharge (.12 x [AD $ 14.76
(C) Technology Fee (5% of[A]) S 6.1'
TOTAL fees and surcharges (A througl1 C): $143.91
NOTICE: THE WORK
THIS PERMIT SHNAOLE~ ~~~R~~~MIT IS NOT
AUTHORIZED U FOR
COMMENCED OR IS ABANDONED
ANY 180 DAY PERIOD.
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.'\~EGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth SI
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00729
162 S15TH ST
permilcenter@ci.springfield.or.us
RECEIPT NO: 2011000854
lbtscRllmON,":i",i,':' :'
Branch circuits with service or feeder each circuit
CASHIER: NMACHADO
RECORD NO: 811-SPR2011-00729 DATE: 0510212011
'; ,.' ,,'i;~,;'ACCOLJi'KCODE~ ,<I, ". AMOUNT-DUE
224-00000-426102 42.00
224-00000-426102 81.00
821-00000-215004 14.76
100-00000-425605 6.15
TOTAL DUE: 143.91
":~ AMOUNT PAID
143.91
Services 200 amps or less
_ .__~ta~<;. of.9.~go-"_:>LI'.:harge (12% of applicable fees)
__ Tec~-""-lcJg~J~ (5%_0.!,~rmit total)
LPAY!'/l.E~tLlY.PE~PAr.QR
Check D2H LLC
058413
CoMMEI',IIS .
TOTAL PAID:
143.91