HomeMy WebLinkAboutPermit Electrical 2011-6-3
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Electrical Permit Application
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~ CITY. OR SPRI~,GEIELIl, QREGON?<~
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225 Fifth Street. Springfield, OR 97477tPH(541)726-3753HAX(54t)726-3689
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.
"t:OCAL;.GOVERNMENT;Ap'PROVAI.;)~<''''''::';'.:f';''';/.l
Zoning approval verified? 0 Yes 0 No
,,"/~cCATEGORYcX6FCONSTRUCTION2;i> . '''.
o Residential 0 Government 0 Commercial
:Ih%:~;,jOB:.SITE~INFORI\IIAl'I6Nt,6;NDl1GOCAt;ION~~#i:j,";F
Job site address: '[} ;t
City:
Name:
Address:
Business name:
/'
Address:
Signature of signing supervisor:
ATTENTION: Oregon 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 \p
Center is 1-800-332-2344). f~
440-2584-) (9108/COM)
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"",' - "',' ',,' .-,," Gost ; Total
'N:urriber' oqnspeCtio'n'sper _ih~m'(.). ",~ ~ Q'ty.
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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 $ ''is 1
20 I 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 anips 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 $ 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' $.;l+ c.>>
Miscellaneous fees: service or feeder '}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: (I) $58.00 $
~~~~~~1~~~{~~ri;r:t~AR.euftANT!~{l5E~;'~'.JJ!;::~~,~f;:f);ltt:y'::,;;.~:':';
(A) Enter subtotal of above fees ( ~(
(Minimum Permit Fee $58.00) $ /d
(B) Enter 12% surcharge (.12 X [All $ /-Z-.-( 0
(C) Technology Fee (5% of [All S'.'-' ,/
$
TOTAL fees and surcharges (A through C): 'if J'~
IV'~
00
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~^:!2 , OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 51
Springfield,OR 97477
541-726.3753
www.ci.springfield.or.us
811-SPR2011-01291
2640 0 ST
permitcenter@cLspringfield.or.us
RECEIPT NO: 2011001433 RECORD NO: 811-SPR2011-01291
lDESCRIP..TION .'. ." p . , '~T' '''' :.':;;- -;::>;~ ACC:OUNLCODE, '-q '-'-
Branch circuits with service or feeder each circuit 224.00000.426102
Services 200 amps or less 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: 06/03/2011
. 'I.' AMOUNHl.UE "
24.00
81.00
12.60
5.25
I
LcE~Yl~t~t:lTr.Y~E' "
Cash
"'_PAY~I3--.:.::..~tsHJER~ NMAc'HADo~l.
Michael Briley
'~'< CPMMENIS: :,.
"-"'-',
,
122.85
".. AMOUNT PAID. c'
122.85
TOTAL PAID:
122.85