HomeMy WebLinkAboutPermit Electrical 2011-7-11
~t~ical Permit Application
D
225 Fifth Street.Sp,;ngr~eld, OR 97477tPH(541)726-3753+FAX(541)726-3689
DEPf.RTMENT USE ONt Y
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.
'L::OC~L:: GOltERNMEN;r . APPROltA",;,~""r;':'r',
Zoning approval verified? 0 Yes 0 No
',.CATEGORV:'OFCONSTRUCTION'"
City:
Reference:
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 intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
Signature:
Signing supervisor's license no.:
'Print name of signing supervisor:
Signature of signing supervisor: ~
ATTENTION' Oregon law reqUlr 'y .
. d b the Oregon U My
follow rules adopte Ye rules are set forth
Notification Center. ThhOS gh OAR 952-001-
, OAR952-001-0010t rou ~
In Y yobtain copies of the rules by
0090. ou ma Note' the telephone
calling tfhe tCheen~;~g(on Utility Notification ~ ~~~
number or 344)
Center is 1_800.332-2 ' . C)'
,~~~
~~
440.2584-1 (9/08/COM)
:.i. ;~;':!.;','"i?:ii:~t~:,~'~':tt~~01~;:~t~-E.EE-;~SCA EtjUltE~?\\)~?;':;':f.;~:f;~~:f,~\~t;:~1~~:7W~~\~'t
,Number"oqnspeciio'ns perit~~' d Q'ty, .Cost I Total
, : -': . ". . .. . :,,_~i" . . _ '.' .. 1- . , ea,', . c.ost
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 $ $
dwelling service or feeder (2) 63.00
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) $168.00 $
601 to 1,000 amps (2) $206.00 $
Over \,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 ofa service"o{feeder fee:
f
Eachtbranc!Uirtuit .-'{DlkE Ifi1S1~ "Tf
.. ..l' . O. "
b Fee 'foA braneft ~rt~lts'W~~'fp~rf~'ge\lJt\i\l\!fvlc~ ~ feeder fee:
1 hJ I ..., \ \ ....
F' b' '~'HrD\tt:C u;;., IC, !\B!\ lDLJ1pt.S' 5500 $
Irst, ,r~_c ,c1rc.1'
Each alditf'JJ1Jr'b'rW a;!.'PPiIOD. I $ 6.00 $
_ '" r-' I'
" 1\1\1'1 'ou v' ".
Miscellaneous fees: servlce or feeder '}ot included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or ~~~~~)~anel, / $ 63.00 $ 63
alteration, or exte si--o-n-R1
Each additional inspection: (1) $68.00 $
'~W~;.'::j~lt50~%~~l,1;,:j~;!~;~!~~~~~;~fAP"eLJc'A:r~t~~1)SE1L~,:\;;'.\:U::j;:-\{r:~{:'~'J;r,:;J,~~':- ".'
(A) Enter subtotal of above fees b~
(Minimum Permit Fee $58.00) $
(B) Enter 12% surcharge (.12 x [A]) $ 7S"'l:
(C) Technology Fee (5% of [A]) $ 'J(F
TOTAL fees and surcharges (A through C): $ 7 <.71
IIIL
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield,OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-01726
250 5 32ND ST
perm itcenler@ci.springfield.or.us
RECEIPT NO: 2011001950 RECORD NO: 811-SPR2011-01726
tOESCRIP.JIOI-r." ....L.:cj~;... <"~_-,-~:.L.:._zt::"":'!:.it,.I,'.i.':L'_-,-,-ACCciIJNfiCciDE:s'J'
Dala 1 Telecommunications 224-00000-426102
---- .~~
Slate of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology fee (5% of permit tala I) 100-00000-425605
TOTAL DUE:
L .;-PAYMENflWPEL"L;PAYORi".";;;~HIER!9"owLs~;i;,;;,g.(,c:ciMllifENTS.;irAL;;7;,' .,;-,. ';'1ll
Cash rj david communication
DATE: 07111/2011
. ,n, ...... I
. -,'.AMOUNT:DUEC:~''':'__d
63.00
-'-------~._-,
7.56
3.15
73.71
,jl.MOlJNT ~A!Q:~~~ '!:'~- ,I
$73.71
TOTAL PAID:
$73.71