HomeMy WebLinkAboutPermit Electrical 2011-4-6
DEPARTMENT USE ONLY
225 Fifth Streett Springfield, OR 97477 tPH(54l)726-3753 tFAX(54 1)726-3689
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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.
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Zoning approval verified? Yes 0 No
,;CATEGORYVOFCONSTRUCtION,:*.i. . .
Residential
!iit)i:&/;S2JQS;;'SITE:
Job sile address:
Name:
Address:2 fj Of
City:
Phone:
E-mail:
This installalion is being made on residenlial 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:
City:
Phone:
E-mail:
CCB licenseno.:20-2-<tCZ
Signing supervisor's license no,:
Print name of signing supervisor:
Signature of signing supervisor'
"0', t?
.2...
ZIP: a.r7 l[ fj
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-D01-D01 0 through OAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utilily Notification
Center is 1-800-332-2344).
440-2584~J (9!08/COM)'
i:~':~;\::~;tt:':~~~~:i;;~"'~~.~hW~;;:~t;;'f-E_-E:'H,-S'OR EJj:o'el;;g,~'~lI~~'?1{;~(~;;Jj~~f~~;}:?;~Ff~
.Number' oq~sp~~ti~'ri~ ~erjte~:O .." Qty. Cost Total'
, ':'. ",' ,,'. .' ': i',: ''''.'' .. '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 $ 63.00 $
dwelling service or feeder (2)
Services or feeders: installation, alteration, relocation
200 amps or less (2) I $ 81.00 $ ~(
201 to 400 amps (2) $ 95.00 $
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 feed~rs: 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 $
Miscellaneous fees: service or feeder not 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 aoditional inspection: (I) $58.00 $
a~:i:f~;f4*~~~%!~~t;j1t~~1~Z;)\B)~~UI'CA'N_*{{U-SEtt~::;t{/;{'h~;-~~:i~;~;t<~'~i;at:.~,:.:;.:.::,
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $ g /
(B) Enter 12% surcharge (.12 x [AD $ 97l
;rd) Technology Fee (5% of [A])' ."~' .' L/oS-
$
tfd'l\ 1 '~}1€'slJndJ,\"r'cl.~d&!I.Gltt.hYo~gli,.'C): $ 9l/77
,....,~ ~. ~~ ..
nlLt:u UIWt:n I nr0 r LnIVlI1 hr"v'
.~
~~.\\v,
~~
~ NOT!
. \}) THIS F
AUTHO
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
;-.
I
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00554
2595 37TH ST
permitcenter@cLspringfield.or.us
RECORD NO: 811-SPR2011-00554
""';-";-27].;' ,. if'::" .'y'0';:'~_;t\cCOlJNtiCO[)E
224-00000-426102
821-00000-215004
100-00000-425605
TOTAL DUE:
13~PAYMENT1;YPE~,;~';PAYORJ:I-c'ASHlER:-080W~SBY~,J,.i4;;:;;;~itq!\l.1iii~i$J;~;~'-', .i', .~',,_.-.
Credit Card GLEN A CAMPBELL
09581g
RECEIPT NO: 2011000668
'O'E SCRIf!TION;.'<"'''-:' ': .t.,
l .,,", ._____~~
Services 200 amps or less
State of Oregon Surcharge (12% of applicable fees)
Technol09yfee (5% of permit total)
DATE: 0410612011
. '. -;~i.AMOUNT.OUE..':"""......._J
81.00
9.72
4.05
94.77
. ~~1Il0LJNTI'Alb,-;;. i., .L..:.J
94.77
TOTAL PAID:
94.77