HomeMy WebLinkAboutPermit Electrical 2011-6-2
1-..
-,
Electrical Permit Application
IJF.Qrif\~~)~~\1}iJ[m~?ifi1fi)}1tpy;~m~'l,WW~~l)E~i
li\'~ l:'~~ ;:).'~ '''~~\''. ,l"....~.t.~~"!1D~~.'~~,.r~{t;L,~..::t1!l!:..~")~:fr.t.D..:::~
225 Fifth Slreet+Sprlllgflcld, on 97477. PH(S41)726-3753. FAX(S41)726.3G89
~PR1NOI=I"LO
DEPARTMENT USE ONLY
pen~(l~O J 'Z b l.{
tlY,
Date: &, Z-: II
This pcnnit is issucd undcr OAR 918-309.,0000. Permits are nontransfcrable. Permits expirc ifworlc is not started within 180
days ofissurUlce 01' ifworJc is suspended fol' 180 dn.ys.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? DYes 0 No
CATEGORY OF CONSTRUCTION
o Residential 0 Government ~ommercial
JOB SITE INFORMATION AND LOCATION
ZIP: 9-7,4 7 8
urn
Name:
co
Address:
ZIP9lf6 Zl
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 intende r sale. exchange, lease, or rent. OAR
479.540(1) and 479. 0(1).
Signature:
CTOR INST LATION
Business name;Olsson Industrial Electric
Address:1919 Laura Street
City: Springfield State: OR
Phone:541 747 8460 Fax:54J.
ZIP: 97477
747 4846
E-mail: doug@olssonelec.com
CCBliccns~no.: 63473 BCDlict:l1seno.: 20-241C'
Signing supervisor's license no.: 33348
Print name of signing supervisor: Douglas Heer
S;gnature of sig11ing supervisor:
ATTENTION: Oregon law requires you.t.o
follow rules adopted by the Oregon Uliltty
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
callin the center. (Note: the tele~hone
4401j,,.p~9/&1ilf:~\J.y Oregon Utility NotlflcatIO,\ ~y ~
C,"to< ;, '-800.32-23'4)- ~~
FEE SCHEDULE
Number of inspections pel' item () Qty. Cost Totul
eu. cost
Residential, pCI' unitl 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 01' fceders: il/s/allaliol/, alremfioll. relocl/tion
200 amps or less (2) $ 81.00 $
20] \0400 amps (2) $ 95.00 $
40] to 600 amps (2) $158.00 $
601 to 1,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporllry services 01' feeders: inslalla/iol/, a{lera/ion, relocalfoll
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 J ,000 volts, see services or feeders section above
Brauch circuits: I/CHl\ altem/ioll, extension per pam!!
II. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit $ 6.00 I $
b. Fce for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2) 1 $ 55.00 $ 55
Each addilionaJ branch circuit $ 6.00 $
Mlscell:llleolls fees: sel1'ice or/eeder 11O! il/ell/ded
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy pcHlel, $ 63.00 $
alterntioll, or extension (2)
Each additional inspection: (I) $58.00 $
APPLICANT USE
(A) Enter subtotal of above fees $
(Minimum Pel'lllit Fee $58.00) 58
(8) Enter 12% surcharge (.12 x [AD $ 6.96
(C) Technology Fee (5% of [A]) $ 2.90
TOTAL fees and surchArges (A through C): $ 67.86
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
-
\.
S~1~N.,:-. FI~
L~~
~OREGOH
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541.726.3753
www.ci.springfield.or.us
811-SPR2011-01264
3315 MARCOLA RD
perm itcenler@ci.springfield.or.us
RECEIPT NO: 2011001411
[DESCRip.TION'-~" ." ',iJ' '-- ". .
Balance of Minimum Electrical Permit Fees
Branch circuits without service or feeder - 1st circuit
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-01264
. v"-""'~AC'COUN:tCC)[jEGL'" ",'
224-00000-426102
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
DATE: 06/02/2011
Lell-XM,E:NT T'(PE~PA'yOR 'cASHIER.'DBOWLSBv:'.'
Check OLSSON INDUSTRIAL ELECTRIC
58636 INC
_C9M_I'!1WrS . .
"AMOUNT_DUE
3.00
55.00
6.96
2.90
67.86
AMOUNT PAID
~;...."',
1
67.86
TOTAL PAID:
67.86