HomeMy WebLinkAboutPermit Electrical 2011-6-16
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225 Fifth Streett Springfield, OR 97477.PH(541)726-3753+ FAX(541)726-3689
SPRINGFIELD
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DE-PARTMENTUSE ONLY. .
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Pennit no. Sf r ~ 15 26
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Date:
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.
;.;.; ,. ":1:!0CAVG0VERNMENT'APPR(:IVAIf:\:i,,"r:i'~i\'r1J:~:.
Zoning approval verified? 0 Yes 0 No
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City:
Reference: \
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Name:
Address:
City:
Phone: ~
E-mail:
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This installation is being made on residential or arm 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) a . .n9.5~J....:?
Signature: .' _. ~ c/.
:CQNTRACTOR INST ALI:.ATlON
Bus'iness name:
Address:
City:
Phone:
E-mail:
CCB license no.'
Signing supervisor's license no.:
Print name of sign ing supervisor:
Signature of signing supervisor:
foil ,'ON: Oregon law requires you to
ow ru es adopted by the 0
Notification Cente~ Those r I reg on Utility
In OAR 952-001-0010 th u es are set forth
0090 Vi rough OAR 952-001- ~ ~ )
ca,jin:fh~~~~~~~I(~~iej:et~~ft~~:;~~e~e by ~-\'\\:J
number for the. Oregon Utility Notification \.9' , '. , ~lY
Center IS 1-800-332-2344}. . ~ ~
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ZIP:
Fax:
440-2584-J (9/08/COM)
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Residential, per unit, service included:
1,000 sq. ft. or less (4) $134.00 $
Each additional 500 sq. f1. 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) $ 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 $t?~.Q ,
201 to 400 amps (2) $ 87.00 $
40 1to 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 additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00) $ (p,.--
\~)r """.r. )% surcharge (.12 x [A]) $ 7>'
~S4 e~~'n. 0,1..0, Fee (5% offAl)' ' "'./. "{J;,t";;~::,;i:,l. , $ .'" "'"
JrilfM'rE !l ;iF, ~rcW[ !ilK $ "l~ ....
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V'WL.n I nl" LnlV'" IS ,
31)'
COMMENCED OR IS ABANDONED FOR NO:. ..
ANY 180 DAY PERIOD.',''''
7? 7'
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x.~~ OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00820
4892 HOllY ST
perrnilcenter@ci.springfield.or.us
RECEIPT NO: 2011001657 RECORD NO: 811-SPR2011-00820 DATE: 06/16/2011
IOE$CRIP}IONr;"' _ ",'-!,;, _f '~;;"~'r '"" ;:'iF?[";1,j',Ji"3f" ,,'AccbUNt~C:OOE':" " "" :';:';'f',AMOllNJiOUE';;::f/' ; I
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 7,56
Technology fee (5% of permit total) 100-00000-425605 3,15
Temp services 200 amps or less 224-00000A26102 63,00
TOTAL DUE: 73.71
,f ,< "COI'IIMENTSI'''J:.;:; g.;'>:,". _" :" AMOUNT PAID'! '
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73.71
1b@r:I'!I~I:lJ_j;XBf;.;:.',.J'_AyO_~ ",' CASHIER:DB~~is~Y_
Credit Card HAYDEN HOMES LLC
052308
TOTAL PAID:
73.71