HomeMy WebLinkAboutPermit Electrical 2011-5-24
c
iIe~~rical Permit Application
8 D
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 tFAX(541)726-3689
DEPf.RTMENT USE ONLY
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.
E-mail:
CCB license no.: t;1:1 'l.k'
Signing supervisor's' license no.:
Print name of signing supervisor:
Signature of signing supervisor: I
ATTENTION: Oreg aw requires you to
follow rules adopte by the Oregon Utility
Notification Center. Those ruies are set forth
in OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note:.the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344). . ~ 1
~\\~
\{)~'(;:A^ ~~r\NY 180 DAY PERIOD.
440-2584-J (9/08/COM). f\W~,\
, t,OCAL':GOVERNMENT APPB,OVAL!'i./"'r',' 'f,
Zoning approval verified? DYes D No
';., . ..:CATEGORY.;OF':CONSTRUC-':ION')~" ,;.
o Residential 0 Government l!(Commercial
~1!m;0'itOB;\;$ITE(INFOR.IIiIAtIONr!AN[j2iL\:()_CATloN:ii1i;;f'" ;
Job site address: . _ _ _ . S' S
City: Y'tJ. State: 0/2... ZIP: 97'( 7
D Z. 33'1 Z Taxlot: 0310Z
DESCRIPTION OF WORK: .:, .' "; ." .
00
Name: (
Address:
ZIP: 974.S-
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 INSTALLATION
a-i "';-~,!\~.:(;~~:.;f;~~t~~~!~ fEE:~,SCHEJjJ.tOE<.~{.?t'1-::'ifl~'il(~~~*~~f~
'.' '....... 'h" "\'" ., ',' :.-,', Cost. Total
Nu~~er ofinspectio~~ per .it~~ ()." Qty. , ea.' . 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 $ $
dwelling service or feeder (2) 53.00
Services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 81.00 $ '61
20 I to 400 amps (2) $ 95.00 $
40 I 10 600 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 $
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 branch circuits with purchase of a service 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 $
Each additional branch circuit $ 5.00 $
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 limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
;~~~{)~V$~~~NRt;?~tApeliic~f\j*f;iJS e\i.,1,t;' ::'?:~};~~:;;:?~f:~:~~;~::~:' ,." ~
(A) Enter subtotal of above fees Sf
(Minimum Permit Fee $58.00) $
,,..,,.....,.,,r:. .- '.- Cf7Z.:
,(B) Enter.12% surcharge (.12 x [AD $
1(0)>l1?tj,'fig~b1iWI~l, J.tJ~irt I~ I.~~C.~V~~C . $ '-(O~
~..~. '~"';,~~\iW 'Ii-'" ~J~lt0-,\)W'!!.~"....,oN $ 9'177
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IUIV!IVIL-t'JuLU UII Iv nUl "....... ..
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- ' .\ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Sprlngfield,OR 97477
541-726-3753
www.cLspringfield.or.us
811-SPR2011-01167
5495 A ST. APT 6
pe rmitcenter@ci.springfield.or.us
RECEIPT NO: 2011001318
lDESCRI~TION" . .
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
"
RECORD NO: 811-SPR2011-01167 DATE: OS/26/2011
ACCOlJNTJ::6DE "'''AMbUNT_DLJE~~
224-00000-426102 81.00
821-00000-215004 9.72
100-00000-425605 4.05
TOTAL DUE: 94.77
,f AMOUNT PAID _
<<-QM.I\'II~~:IS
~ ",'
I
L PAYMENT_D'I'i::~AY.9~" CASHiER'DBOWLSB'!.
Check
7503
lite electric service
94.77
TOTAL PAID:
94.77