HomeMy WebLinkAboutPermit Electrical 2011-5-31
Electrh;~1 Permit Application
225 Fifth Street. Springfield, OR 97477+ PH(541)726-3753+ FAX(541)726-3689
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DEPARTMENT USE.ONt. y
Permit no. ,) / I - 1:2"3 I
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Date: /--' 1/
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. .
, LOCA,L:.GOVERNMENT APPROVAL
Zoning approval verified? D Ves D No
'CATEGORY'OF:CONSTRUCTlON '.
City:
Reference:
PROPERTY. OWNER
Name:
City:
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 intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
CONTRACTOR INSTALLA,TION:
Business name:
Address:
City:
Phone:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
440-2584-J (9/08/COM)
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.Nu~ber' of im;pecti.~'ns .~e.r .it~m.~) Qty. Cost Total'
>~a. cost
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: installation, alteration, relocation
200 amps or less (2) $ 81.00 $
201 to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
60 I 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 $
20 I 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 pane!
a. Fee for branch circuits with purchase ofa service or feeder fee:
Each branch circuit $ 6.00 $
p. Fee for branch circuits without purchase of a service Or feeder fee:
First branch circuit (2) -/ $ 55.00 $t)5-
Each additional branch circuit $ 6.00 $
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 Iimited,..;energy panel, $ 63.00 $
alteration, orextension (2)
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees 5g~
(Minimum Permit Fee $58.00) $
(B) Enter 12% surcharge (.12 x [A]) $ 19t,
(e) Technology Fee (5% of [A]) $ ?, 9()
TOTAL fees and surcharges (A through C): $t/; 7 ,J(J"
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-5PR2011-01231
614 G 5T
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
permilcenler@ci.springfield.or.us
RECEIPT NO: 2011001372 RECORD NO: 811-SPR2011-01231
tDESCRIP..TION' :,",-". ".'';.-. ,,-"C- ~. ,,"0M,"&;",'0.\l,\ccou-r\i:T~CODE;:'-:.'-
Electrical Inspection For Which No Fee is Specifically Indicated 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: 06/01/2011
I_PAYIV!E~LD'P..E-,-- _~!\Y.o!L C"SHIS~ CCA~E!!.TER~_ .:.....-.c.::COMNiE!-I:rS' r
Check Livewire electric
013606
, , ,:/':"AMOUr-H-DUE
58.00
6.96
2.90
67.86
AMOUNT PAID
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67.86
TOTAL PAID:
67.86