HomeMy WebLinkAboutPermit Electrical 2011-4-29
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Electrical Permit Application
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~CITY OF SPRINGFIELD, 'OREGON ~
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DEPARTMENT USE ONLY
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Date: ~ Z ? - I(
225 F;fth Street. Springfield, OR 97477.PH(541)726-J753+FAX(541)726-J689
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.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
Residential D Government D Com mer
JOB SITE INFORMATION AND LOC TION
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City: ZIP:??
o
Name:
Address:
Phone:
E-mail:
This installation is being made on residential or farm prope
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. 0
479.540(1) and 479.560(1).
Fax:
Signature:
CONTRACTOR INSTALLATION
Business name: ELELTKlc...
Address: PD. EDl<: 2.5'8;;)
City: EiA. E:"/J';: State:OR... ZIP:
Phone: 5"1.4 I -52D '[J"(/J(P9 Fax:
E-mail:
CCB license no.: '1"S"1JQ
Signing supervisor's license no.:
Print name of signing supervisor.
Signature of signing supervisor:
.
ATTENTION: Oregon law requires youto
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 ruies by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1.500-332-2344).
440-2584.J (9/08/COM)
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FEE SCHEDULE
N'umber of inspections per item ,() Qty. Cost Total
ea. cost
cial Residential, per unit, service included:
1,000 sq. ft. or less (4) r $134.00 $/'3Cf
Each additional 500 sq. fl. or portion Z $ 25.00 $~
thereof
'(77 Limited energy (2) $ 32.00 $
beo Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps nr less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 tn 600 amps (2) $158.00 $
- 601 to 1,000 amps (2) $205.00 $
I{O, Over] ,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
rty 200 amps or less (2) $ 63.00 $
AR 2(1l 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, alteration, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6.00 $
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 not included ': /
Each pump or irrigation circle (2) $ 63.00 $
Each sign or oulline lighdng (2) $ 63.00 $
_.II ~ Signal circuit or a limited-energy panel, $ 63.00 $
~ alteration, or extension (2)
'Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees
~ (Minimnm Permit Fee $58.00) $ I Xt(
(B) Enter 12% surcharge (.12 x [AD $ t2 ..~
I\!OTIC (q Technology Fee (5% of [AD .' q $ 9;'0
THIS PE rmlJJ,T~~e,~l;1ie):$liR:!i:ifgilSliK lli'.&\ligt, C): $?I<;'Z ~
AUTHORIZED UNDER THIS PERMIT IS NU I .
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COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
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TRANSACTION RECEIPT
CITY OF SPRlNGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00714
816 S 32ND ST
permi1center@ci,springfield.or.us
RECORD NO: 811-SPR2011-00714 DATE: 04/29/2011
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224-00000-426102 50.00
224-00000-426102 134.00
821-00000-215004 22.08
100-00000-425605 9.20
TOTAL DUE: 215.28
i."PAYMENT TYPE -. 'PAYOR~- 'CASHIER~DBOwLSBi(-"'-~-~;'COMMENrS'''- "'.r.c..>_', ,.. <. 'AMOUN. T,PAIO" :. ..:' i.
..,.._.~ .,.... _" "......,.,_..... "_,.,C. '_~__'" .. _ "..."....--'-~_~__..._. "'"__.._.,,",___._4 ~_""_"""""'" ... ,......... .~_~_~_~______. ~.,~~_...............-"o________,_..,~_~"..._
Credit Card dane butler 215.28
07511c
RECEIPT NO: 2011000835
lOESt:RIE.TION" "'.", :;i~M~':5:;iri-
Each added 500 sq. ft. or portion
Residence wiring 1,000 sq. ft. or less
State of Oregon Surcharge (12% of applicable fees)
Technolo~y' fee (5% of permit tolal)
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TOTAL PAID:
215.28