HomeMy WebLinkAboutPermit Electrical 2011-4-29
Ele('.Jri!~1 Permit Application
. .
1'1 DEPARTMENTus'E ONL. y
p~;,~' . .
SrtlZ-O((-Oo 72-0
Penmt no.:
Date: i.(-Z i -1/
225 Fifth Streett Springfield, OR 97477. PH(54t)726-3753+ FAX(541)726-3689
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.
.' .' . :"'!ZbCJ1<L;:GOVE.RNMENT ;AF?",ROYAE?2'!'",:"~';
Zoning approval verified? 0 Yes 0 No
"':.}:\lCATEGORYN6~.:'J':ON~TI3.UCTION1,'f;; .
City:
Reference.
Name:
Address:
City:
Phone:
E-mail:
T.his 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. OA
479.540(1) and 479.560(1).
#-IIL
ZIP: ''If')t-/
ZIP: 1''74
E-mai!:
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor: .
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... .: _, 't', ~.~').~f,,",~ c','"" /:>$. .1,' _:~.... . ;,,: .' __.. ',,';',"f- 'c;r-., ,~i:';::,"J'+\'~,>,~:~;Jf"':'!',-:.r.".:::
. . '. ," ..' .........' ,., f'os~ Total.
;J\lumber"QfJn,specti~'ris:per,it~in:C)' ~:.. Q'ty.' .,
"",.",,' : . ~.: ';'.,. ",,,,e', '.,^_' "[::' .,,:,.'t', ' .~ ",,, "',\., .; .I~:':'.'~,. '_~. .';_ J_l.\"ea.-, ".' cost, ,'.
Residential, per unit, service included:
I
~~;;~\t;;tS 1,000 sq. ft. or less (4) $134.00 $
q,\ Each additional 500 sq. ft. or portion $ 25.00 $
thereof
r7~ Limited energy (2) $ 32.00 $
b Each manufactured home or modular $ 63.00 $
:;'j. ...~'O; dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) 1 $ 81.00 $ R/
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
1~ 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 $
R
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 I $ 6.00 I $
tJ1 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 $
t"t~ Miscellaneous fees: service or feeder l}ot included
Each pump or irrigation circle (2) $ 63.00 $
(I 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 $
~\n. ,~~~~~~l%:~~};4{rf~~~AReiYiG~~Nt?~lJS-E\~~~2%.~~1;'~:~;013;~:E~,~7~, l~;~
~ (A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $ g(
OTICr(B) Enter 12% surcharge (.12x'[A])" $ y7Z
HIS PII(~):tec n oe'e~5% ?i[p,Jtc VVunt\ $ lfI:J)
UTHO' ,- , +~,',~' ,II._,~ "~-
',1 ''f;''-'r'A'-I'}~ ~I-' '.' "u ~";~~~:i(.f,vgh $QU7
OMMH,1i e!-'a~M~!:flfllr,ge ( \ oug C):
" '- ,. . . . ( f
ATTENTION: Oregon law requires yout,o
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. (Note: the telephone
number for the Oregon Utility NotificatIOn
Center is 1-800-332-2344).
~~
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T
A
C
ANY 180 DAY PERIOD.
440-2584-J (9108/COM)
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SP. RIN.. G.FIE. ~o
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i.'.~."" OREGON
TRANSACTION RECEIPT
C1TY OF SPRINGFIELD
225 Fifth S1
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00720
213 38TH PL
perrnitcenter@ci,springfleld.or.us
RECEIPT NO: 2011000840 RECORD NO: 811-SPR2011-00720 DATE: 04/29/2011
lDESQRII~.TION. .;'0","" ., '~~7;-l ....T~~~'10~~3*""~,i~;t;;, - """:,.p"C:coliNrIC.QDE'.i"-+M " "-'f"',.";MOUN'flDlJE44€'t,
Services 200 amps or less 224-00000-426102 81.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 9.72
.~.Technology~fee (5% of permit total) 100-00000-425605 4.05
TOTAL DUE: 94.77
t-,~AXMENf. TYRE,,':~';":R~ Y9'~f::~c1~H1ER'1i9WL~ID-;\~Xr:.' \'C.QI!'LIIII}=ti.IS, '.~'.: '.~ ;',:.1:,.: "~_: "';.I!t2IJJ:!l:.P.!IJ.~L._" :, " ...-::-1
Credit Card GLEN A CAMPBELL 94.77
07590g
TOTAL PAID:
94.77