HomeMy WebLinkAboutPermit Electrical 2011-5-27
"EI~ctrical Permit Application
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rl:ITY OF SPiuNGFIELD~:ORE-G6N'~:; <
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225 Fifth Streel+Springlield. OR 9i..an+PH(S41)726-37S3t FAX(541)726~36lS9
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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
I 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
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:
Signing supervisor's license no.:
Print name of signing supervisor:
S. f ..TT"'''Tln~I' Oregc "t',I'lty
19nature 0 slgnmg s~perv~~,Qr:t .: I ,tl (: G n co U
OliUVY 11,.0."".... "1' e ru ~s Q!.... I
Notification cen~~10':~~OU9h OAR 952-001-
in OAR 952-001- btain copies 01 the rules by
0090.. You may 0 Note: 1he telephone
callmg the cen~r~ (on Utility Notificatton
number tor the r1 8g00-332-2344~
Center IS - ;\V
\p.~.~\ oJ
~~
440.2584-) (9/08/COM)
FEE SCHEDULE - ,
Number of inspections per item () Qty. Cost Total
ea. cost
Residential! per unit, service included:
1.000 sq. ft. or less (4) I 5134.00 5
Each addilional 500 sq. ft, or panion I I 5 25.00 $
thereof
Limited energy (2) I 5 32.00 I 5
Each manufactured home or modular $ 63.00 I $
dwelling service or feeder (2)
Services or feeders: installalion, alteration, relocation
200 amps or less (2) 1/ $ 81.00 $)( I
20 I 10400 amps (2) I I $ 95.00 $
401 10 600 amps (2) I I $158.00 $
601101.000 amps (2) I $205.00 I $
Over 1,000 amps or volts (2) I $469.00 I 5
Reconnect only (2) $ 63.00 5
Temporary services or feeders: inslqj!ali~'(j{7etalion relocalion
,~ ~.
200 amps or less (2) 'o/\l\\'-.t. II" ' fnS ~\l\ $
f'" _ ,,1\ $ 63.00
,f2Qit;'otloo .~.,,!~\2\,1..\.. ~~I'\S ft.' ~~. f\ to \ 5 87.00 I $
.' ",' ...n ~ ....."
_ \4,\fJ 16'6W;~,~..i2)\)~~' ~\)r>-~\JV"'I 5126.00 5
"'\"\-.I'd \.- r~l,r ,--
~<i>Ser._~ ~Q:~~r ...'~~\~,?;!J~. see services or feeders section a~ove
Il "\\1\ , .~ e. ~~n~:-' . .
ra.~~h... cArcu.!ts: n w, alteral/on. extensIOn per panel
alSFt~ for branch circuits with purchase of a service or feeder fee:
Each branch circuit I I $ 6.00 5
b. Fee for branch circuits without purchase of a ser\'ice or feeder fee:
First branch circuit (2) I 5 55.00 I 5
Each additional branch circuit I I 5 6.00 I 5
Miscellaneous fees: service or feeder nol included
Each pump or irrigation circle (2) I $ 63.00 I 5
Each sign or outline lighting (2) I $ 63.00 5
Signal circuit or a limited-energy paneL I I 5 63.00 I 5
alteration, or extension (2) .
Each additional inspection: (I) I 558.00 I 5 I
"':-> '. .APPLlCANT USE 1,\
(A) Enter subtotal of above fees $ <b1,C
(l\linimum Permit Fee S58.00)
(B) Enter 12% surcharge (.12 x [A]) I $ C1.17k-
(C) Technology Fee (5% of [A]) I $ ?-/-. (D
TOTAL fees and surcharges (A through C): I 5lfu .lfl
00
.
. SP. RIN.G.. FIE~
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,', OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811.SPR2011.01191 .
728 61 ST ST
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
permitce nter@ci.springfield , or. us
RECEIPT NO: 2011001331
lDESCRIP-tION -
Services 200 amps or less
_Stat". of OreJl..on Surcharge (12% of applicable feesY.
.~chno!5'_~ fee (5% of permit total)
RECORD NO: 811-SPR2011.01191
DATE: OS/27/2011
ACCOUNLCODE
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
. AMOUNT.DUE
81.00
9.72
4.05
94.77
AMOUI'!T PAI~_,--_____
94.77
",,'
LEAYMENT T-Y.PE '
Credit Card
005648
"PAYOR,. CASHIER, NMACHAOO ,. ,i"".%<<.OMI\I!ENTS-",,'"
BEAR MOUNTAIN ELECTRIC LLC
TOTAL PAID:
94.77