HomeMy WebLinkAboutPermit Electrical 2011-6-13
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Electrical Permit Application
225 F;fth Street. Spdngfield, OR 97477. PH(54 1)726-3753 . FAX(541)726-3689
""DEPARTMENT I.H3'i: ONLY
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Date G - /5 - Zo II
This permit is issued under OAR 9]8-309-0000. Permits are nontransferable. Permits expire if work is not started within ]80
days of issuance or if work is suspended for ]80 days.
iY, . -! '\'IEOC';L(GOVERNMENT;(,6;rl"'RovAI1l~~;'"~ii!~;f;;'i'";t;i,.
Zoning approval verified? 0 Yes 0 No
~; '::c.'; -;"~'1,,CATEGORy:rbF, ;;CONSlRUCT:IOr.n,\",.. .. ".
o Residential 0 Government 0 Commercial
f!.~V'fi~QJQl3iSI'EE;~INF.ORM)I.'I]ONi:rA..ND~lIb_CJl.TIONJ.'~'f';IiJf"
Job site address:
City.
-,:i~.~}~V,;c:;':.J;~ :;0.;'
ZIP:
Fax:
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:
:CONl:RACi;OR INSTALL&;TION:
E-mail:
CCB license no.:
Signing supervisor's license no::
Print name of signing 'supervisor:
Signature of signing supervisor:
l~ -L..--
440-2584-J (9/08/COM)
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.' . - -, ..> _ '~.'_.,_"" . ",'. Yl.:';tvf;"';J~f c' . . "'.: _' __ _ .. .. '",":. ,,,.. ;: ~"~'. "":;:: . ~. . ;;''!.,,'~
" >: .. '". ':'-,'- ......":'."..'~. ;." .~';-'. ". Cost, Total
,Number' Of inspecticln"s 'per"iiem~'(). ~',;-", Qty,: "'~' "~ea/~_ . ,. <pst. .'.
':"", . ~"'i. ,,;.,,;- ':.' '':'~., #;",,';' ~(,';i" ",1" . '\;,~:F," ,,\.
Residential, per unit, service included: .
1,000 sq. ft. or less (4) $134.00 $
Each addition,al 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 $a.Ct
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 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: 1JfYVrf!!,tf1QQfifl!r, e;-Vr:nsion per panel
a. Fee for branchlE",cuits'1:':ith,purlk\seu6;;'hk~l\!iE<,ijf1feelleYM: to
, ... . -''''-' a UUIA I ';'" '.
Each branch ~i~~!t~a~/;,n Center. tho;J;Jj;:~R6''in $-II/lily
b. Fee for branOOcircuifuBIt~MI/; ~fy@ll.'I'1 frs~hl{i~
~...,. If R\ hf
First branch ciRFuW["j the Cente; ~ .".t~i~& u:tes by
...~. , .
Each additional b~a~~~,h~gn~ Oref- on U'i!iffv,~-8p,: "):~Ie
Q" -
Miscellaneous fees: service or feeder ~~tY~6\ti344).
Each pump or irrigatiC!n circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signa] circuit or a limited.energy panel, $ 63,00 $
alteration, or extension (2)
Each additional inspection: (1) $58.00 $
:::;7t~}}(~~W0Jfi,F{1~~;Y'~;ARP.:i1TC'~'" }fr.'. 'SE";"<t""'~":';~Zt,:;"~i-i;'J:r'f,';)'~"':.
1(i; :,...,' . -..\'::~ft;ft;;_ii-'..,~.:'~'::~ ..'t. ~1 '. . . .ANI'!'7U. . ~;,;~,#,~,r,:~.~'h1J>.c~~fN~.f.4E.:n-,,;;:-\~:t,,\..~
(A) Enter subtotal of above fees $ :?/ ~ V
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [Al) $ 9- ?~-
(C) Technology Fee (5% of [Al) $ '7~
TOTAL fees and surcharges (A through C): $ 9~. 7
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~OREGON
www.cLspringfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01413
102 WOODLANE DR
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541-726-3753
permitce nter@ci.springfield.or.us
RECEIPT NO: 2011001591
lDES'CRII~.TibN< ~,,". ~> ;;'':;';.<" ",';<0 ,";;.. fr
Services 200 amps or less
State of Ore90n Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
RECORD NO: 811-SPR2011-01413 DATE: 06/13/2011
,.c,,,;,j ,.,;,,!'~T;AC:CO.uNfd::.ODE "!::;''''''; ,,'AMOUNT.DUE'
224-00000-426102 81.00
821-00000-215004 . 9.72
100-00000-425605 4.05
TOTAL DUE: 94.77
:' " ..,'AMOUNTF'AID, ,<
'___'_,w,~"""",-,_~,
94.77
L.PA't'M~i:J.T"-txf1J=~:~.PcP:'t'QrL.CASHIE~HA[6~~]A:;j::.ciMME~f.S';,:;,;:'r
Cash JESSE RODOLF
01373a
/~
TOTAL PAID:
94.77