HomeMy WebLinkAboutPermit Electrical 2011-5-9
EJedrical Permit Application
225 Fifth Streett Springfield, OR 9747HPH(541)726-3753tFAX(541)726-3689
DEPARTMENT USE ONLY -
Permf~7..0f(-CO 7g0
Date: 5-'r-l (
This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for 180 days.
'l:OC~L; GOVERNMENTAPPR0VAL~''''--
Zoning approval verified? R! Yes D No
<C~TEGORy.iOF :CONSTRUCTION::;e,
o Residential .0 Government Commercial
~~:jtO.I3;;;SIT:Ei:INFQRMA;tloilli!~NI:l;'IIO:C:AT:fON(Jlj1;i:;i;;r!
Job site address: .30'.2.. 5:-
City:
";-,
Name:
Address'
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 rent. OAR
479.540(1) and 479.560(1).
Signature:
Business name:
City:
Phone:
B-mail:
Signature of signing supervise .
ON' I b'!tlW ese
~1T€.N\\es adopt' \'lOse lilieS ~~ 9S'2.-GG~-
\0\10'1'1 ~~on centelo'. 0 t\'l101l9\'1 01 \\'Ie lilieS b'!
tiliC"'" 0\-0' nies 0 \'lone
tlo .a 952.0 btain co,.. . tlie tele? \iol\.
\n 01"" (1'0.'1 0 ~NO\e. \,<o\\I\Ca.."
0090i\,;~~\'Ie cent~~e90n \J~~:h'4). '~, \.
. ca \oel 101 \\'Ie. s ~ _BOO-3 o?-v {)
..~ ~.' '$/
.~
440-2584-J (9/08/COM)
,~' .,: ' : ':'-,;}~.~,,~~;;';",\<~{f;ii;;:~t,"~:;?-,~: t,E E.;~ S CH E"D.l2J ~E: ;!:~.'''l}'f~:';~i~;(?;:}~';j:;l~~~~W~~~~t~~~
-' . Cost. Total
Nu~~er' 0.( inspe~tio~s ~~r..it~.~-(,). Qty.
.. ea; ~ost: '..
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 $ 63.00 $
dwelling service or feeder (2)
Services or feeders: instal/C!tion, 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 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $459.00 $
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 $
40 I 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 braI")ch circuits with purchase of a se'rvice or feeder fee:
Each branch circuit $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) / $ 55.00 $ S('
Each additional branch circuit .6 $ 6.00 $ :SO
Miscellaneous fees: service or feeder ':lot included
. Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited~eriergy panel, $ 63.00' !",,'f-
alteration, or extension (2) .._.,l ..
Each additional inspection: (1) . ~~~W ~\)\ ,
..,",..'..,."'"..":',,..h'.....'..ARP'C "'Nt..~'t:\":~~\\".J --.
::w1i_,~'/\~"-:,::/..J'~~~~t~~}:?~~~.. ,,~,1I -:A ;' :;?U ,,_,..' .._ ->-,,i ,...,:.;'.:-<~.:
(A) Enter subtotal o~.bove fee~~\.\. '\:.~\\\S <(~~'t-\) ~ ..
(MinimumJl.(~IF1o"e @l:,(\'t-"-", t>..~\) $, f? S-
(B) Enter 12'J; ;UW'a'r~~(1t)} ~ \'0:;' $ /0 ~C>
,. ,
(C) Technolog~W5i~I'l't'fA~ -J'V't-W\J' $ '1=
"'WO~ g~n '19'1.
TOTAL rees aQft.suro ~ (A through C):. $
f>-.\'< '
.
SPRIN.G. FIEl;1i
.--
.: i/t1J
:,;<:...,\ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00780
302 SHELLEY ST
permilcenter@ci.springfield.or.uS
RECEIPT NO: 2011000908 RECORD NO: 811-SPR2011-00780
[DESCRIP.TION .L: .;.,. _ .:...;T~.,. ,. I;\C.CQUr'l:tC.ODE..
Branch circuits with service or feeder each circuit 224-00000-426102
Branch circuits without service or feeder -1st circuit 224-00000-426102
---------...----
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology fee (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: 05/09/2011
I;\MOUNLDUE
30.00
55.00
10.20
4.25
99.45
. AMOUNT PAID'
99.45
,)
L~ YII!E!lI iY~!'....c.::.-P-"'Y_O_R CASHIER: "BOWLSSV"
Check JB ELECTRIC INC
122012
9.o.II!.M!'JiIS
,-
TOTAL PAID:
99.45