HomeMy WebLinkAboutPermit Electrical 2011-6-9
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Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477+ PH(541)726-3753+FAX(541)726-3689
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:tDEPARTMENtUSE ONLy
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Date:
Permit no.:
This permit is issued under OAR 918-3.09-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
NOTICE:
THIS PERMIT SHA
AUTHORIZED UNO
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
., .' . '::L{OCAVGOVERNMENT:';a:~PROVAl:!bt1i,\rnfi!"'n:.
Zoning approval verified? 0 Yes 0 No
;':"';;;'f'..S3,CATEGORy,{OI7:;:CONSTRUC;1110N~:;t
D Residential D Government D Commercial
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Job site address: "ILl C-A ~ /;:; t..t..JA i;;/.:
City: ZIPor' '1
702.-3233 TaxlotDJ~
:'DESCRIPtION: 0F'W()RKjj~, '" :"\;"'?J:;;:F<'
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Name:
'PROPERTY OWNER ..
f' .J tI t1/Jt f'
i
n
Business na.me:
Address:
City:
Phone:
E-mail:
CCB license no.:
ZIP:
BCD license no.:
Signing supervisor's license no.:
Print name of sign in superv.isor:
Signatur ( ~'1f(j R!'d b the Oregon Utility
Notification Center. Those ru es are s
in OAR 952-001-001 0 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).
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440-2584-J (9/08/COM)
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',_NlJrriber'o.f:inspectio:ns~pf;rjte~:__(-)" '." Q'ty. ','1"-."" ,/\-" _'.
" ", .,;-:',.,'.,C t' ,.,' ;i'~'~'+"cf'; ..jc';.'I :,..q.. " ,'~::'.'~~. '. .''-' ,1_1",e!l.'~' '_' 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) $ 96.00 $
401 to 600 amps (2) $158.00 $
601 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 $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2) .A $ 55,00 $ 5~
Each additional branch circuit 'I $ 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 limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees 67
(Minimum Permit Fee $58.00) $
(B) Enter 12'Yo su,~,h.'";g<;,(.12 x [A]) $, 80(1
, (e\ Techno\< (~"{rmj(\]) $"<3 :;-
~ e,s (A through C): $ 7523<
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. >"""", OREGON
TRANSACTION RECEIPT
CiTY Of SPRiNGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01014
4146 CAMELLIA ST
permitce nter@ci.springfield,or.us
RECEIPT NO: 2011001508 RECORD NO: 811-SPR2011-01014 DATE: 06109/2011
[DESCRIP..TION0l;/ ,:'~iJ.." c' ""~. "S;: c,7'":?~i;i.' ,:~"; . ,jACCduNT:.CODE:f.;'.' "::,,,c'~:AM()UNT;DUE'+;" 'c'l
Branch circuits without service or feeder -1st circuit 224-00000-426102 55.00
Branch circuits without service or feeder - each additional 224-00000-426102 12.00
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 8.04
~echnology fee (5% of permit total) 100-00000-425605 3.35
TOTAL DUE: 78.39
.". . ""YAMOUNTPAIQ.._ ',;. 'L-..J
78.39
l..:..eAXMEN:ro:.1ieE'c ..S ....~AY.Qi'l/' cASHIER:.DBOWLSBY 1,~.';:::''' "..c:.OMMENJ:S;;-~M .:
--Select-- paul gross
192443
TOTAL PAID:
78.39