HomeMy WebLinkAboutPermit Electrical 2011-6-1
Eiectr'lcal Permit Application
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 tFAX(541)726-3689
-<'..<";'.~,;'_:.:'."'-"""'-l!'A""...t~:~~~-..., "'"
liJrf;j~E~ARTMENji<lJSE0NIiYi' iiti
Jfc_:,-l;' f"''':-'<-'''''':'';_'i:?'':;~;~!'~M''~~.~"'.,_. ". ~:
/1-S~2dI-<9/d
enmt no.:
Date:
This permit is issued under OAR 918-309-0000. Permits are nODtransferable. Permits expire if work is Dot started withiD 180
days of issuance or if work is suspeDded for 180 days.
/
City:
Phone:
E-mail:
This installatioD 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:
. ,.,~~!:)S:1:Ni!!~fg11Ql~~I.~~m~~i!gillIQN~i~1;W
Business name: ' S f,J
Address:
o
City: /if/. C
Phone: s-=
E-mail: ~~ h ufS
CCB license no.:./I'%?'/
Signing supervisor's license no.:
Print name of signing supervisor:
1yg5
-Z~-z..-.
I-c.-
Signature of signing supervisor:
440.2584-J (9/08/COM)
Residential, per unit, service include"d:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. ft. or portion $ 25.00 $
thereof
Limited eoergy (2) $ 32.00 $
Each manufactured home or modular $ 63.00 $
dwelling service or feeder (2) Services or feeders: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 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) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
$ 63.00 $
$ 87.00 $ .
$126.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
201 to 400 amps (2)
40 I to 600 amps (2)
Branch circuits: new, alteration, extension per panel
a Fee for branch circuits with purchase of a s"ervice or feeder fee:
Each branch circuit
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
$ 55.00 $
$ 6.00 $
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
$ 63.00 $
$ 63.00 $
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
-'.' '.';;E"""I';;'~'A"'N'5'''"''S~E'';ll'!'ii'~\",':'r''''"", .'
~Ii";. n>_L:_~."d"_~u_ .~J~.-s..\-'ii!<-~;=.,," ~
(A) Enter subtotal of above fees g /.
(Minimum Permit Fee $58.00) $
$ 63.00
$
(B) Enter 12% surcharge (.12 x [A]) $
(e) Technology Fee (5% o[[A]) $
TOTAL fees and surcharges (A through C): $
l ."
SP~I.,\.~....;=.~
~\~
~OWEGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01246
643 61 ST ST
permitcenter@ci.springfield,or,us
RECEIPT NO: 2011001389 RECORD NO: 811-SPR2011-01246 DATE: 06/01/2011
lI::1ESCRIflJ:ION' - ',x;' ','>: ,';",;, . ";"-,,,,1',; - " AC.c.b.UNLC.ODE" :'7 . -'-'--':AMOUNJ.DUE.I
Services 200 amps or less 224-00000-426102 81,00
State of Oregon Surcharge (12% of applicable f<:.es) 821-00000-215004 9,72
Technology fee (5% of permit total) 100-00000-425605 4,05
TOTAL DUE: 94.77
L~I'AXM~f:iLIY.I'.~.".-'-_I'AX9R 'CASHIER: NM~!i~~.o--,:';;_:..:.__::~OM.Mif:iIS~~~..~_ AMOUNTPAIP .
Credit Card Linn P. Moore 94.77
33230P
TOTAL PAID:
94.77
.