HomeMy WebLinkAboutPermit Electrical 2011-7-7
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Electrical Permit Application
. , 225 F;Hh StreettSpdngfield, OR 97477tPH(541)726-3753+FAX(541)726-3689
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""DEPARTMENTUSE ONLY
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Pennitno, S/(-o! 9b
Date - 7 - /
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. 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? 0 Yes 0 No
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, ESCRIPTION, OF' W()~K';i;,.:t:?:j,,:..,::;~:'1('.:
Name:
Address:
City:
Phone: '
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 i ended for sale, exchange, lease, or renl. OAR
479.540(1) an 79.560(1).
Signature:
,CONTRACl;ORIN
Business name:
Address:
City:
Phone:
E-mail:
CCB license no.:
ZIP:
BCD license no.:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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. ....,:.. .,-."," , Cost' ,Total'
,Number of inspeCt[o'rispei-it~m'O' ." Qly,
~. .....,';~.-., ........~,..,,:.,. '~;;'~.,"i"';-'f(,<'''-~,v ':O!""" .\,~,~'~.., ,. ,,;'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) $ 81.00 $
20] to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $158.00 $
601 to t ,000 amps (2) $205.00 $
Over 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: instaUation, alteration, relocation
200 amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
40t to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or f~eders 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 I $ 6.00 I $
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch. circuit (2) ( $ 55,00 $ 'J
Each additional branch circuit ( $ 6.00 $ (" .( l)
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 $ b(
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$ -j3Z
L '~'E:llr~nPiOOI!1f11l'l\Sitjj'aBMIT IS NU 1 $ yO)
vftc;mE9roo4fidAlUA:iID~~~h C): $ 71 37
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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
Center is 1-800-332-2344).
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~~ NOT
~ THIS
AUT
COM
ANY 180 DAY PERIOD.
440-2584-1 (9/08/COM)
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Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
ompleted structure and my general contractor is:
Name
CCB#
Expiration Date
D . I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
D
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
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Permit#:
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1236 1"Mu.. ~
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-pg Date: (>
Address:
Issued by:
This Copy for Permit Offices
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,", OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.U5
811-SPR2011-01696
1236 JANUS ST.
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001909
lDESCRIP.JION 2; .
Branch circuits without service or feeder - 1 st circuit
RECORD NO: 811-SPR2011-01696 DATE: 07/07/2011
~"'" '~AC::COUN:(CODE '~.:AMOUNJ_D.LJE
224-00000-426102 55.00
224-00000-426102 6.00
821-00000-215004 7.32
100-00000-425605 3.05
TOTAL DUE: 71.37
: AMOUNT PAID
$71.37
Branch circuits without service or feeder - each additional
--_..'- .., _.__._,- _.~--- --.------...------
_5..tate of_Ore_go~_Surcharge (12% of appli~able fe,,-s)
Technology fee (5% of permit total)
PAYMENT TYPE.
Credit Card
96390b
. PAYOR ,_ . CASHIER:DBOWLSBY
george kimball
COMMENTS " :-';,-
TOTAL PAID:
$71.37