HomeMy WebLinkAboutPermit Electrical 2011-5-24
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Electrical Permit Application
225 Fifth Street. Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
. DEP~RTMENT USE ONLY
Dale: S
16g
Permit no.:
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.
ATTENTION: Oreg law requires you to
follow rules adopted by the Oregon Utility
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
calling the center. (Note: the telephone
number for the Oregon Utility Notification THI
Center is 1-800-332-2344). 1'\(\ I \\AIJT
. ~~\@rv
\f"~~',NY 180 DAY PERIOD
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'EbCAL;<:>OVERNMENJ AP,PROVAG'".."'T':
Zoning approval verified? 0 Ves 0 No
.,' '~'CATEGORY':OFCONSTRUCTlbN),
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ZIP: cnV. S-.s-
Fax:
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:
CCB license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
~rj\,>\......
440-2584-J (9/08/COM)
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. '.' ... ,Cost Total
.Nu~~~~' ~fin~p~ci!o'~~ per _i.t~~ ().. Qty.
- . - . .' , , ~~.'. 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) I $ 81.00 $ ~I
201 to 400 amps (2) $ 95.00 $
40 \ 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 $
201 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 panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit S 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 $ 6.00 $
Miscellaneous fees: service or feeder t}ot 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: (\) $58.00 $
,:~i~~~1~~iM~7~~iIt~~l~AR~,i2IC_A'Nt~,'US E~~~',l:'~{" ~X~~~;:l:~~~~_!(f:;~'-.:'.:
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $ ~ I
. -(B)If;~ter 12% surcharge (.\2 x [AD .. '., $ 97Z'
:; (c):fJ'chlrolllgy!f'et_(5DXlOffi:fi.J1F THE WORK $ L(D~
~t~!t~IllJrJJj\'~1'iIPsunH~f~ ~,tfrlTrdllgh! ():f: $ 9Lf :J-
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:'. "'\ OREGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01168
2290 MAIN ST
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
permitcenter@ci. springfield ,or. us
RECEIPT NO: 2011001319
lDESCRI~TION "
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-01168
DATE: OS/26/2011
., 'AMOUNT:DUE-
81.00
9.72
4.05
94.77
AMOUNT PAID'
94.77
,
"
.,_.-,.
ACCOUNT-CODE." ", 'J
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
_.I'AYMEJIlTJ"'(I'E
Check
7503
.. ~...XOR . CASHIER: OBOWLSBY
lite electric service
.' COMMENTS"
- ~_.- ---------
_J
TOTAL PAID:
94.77