HomeMy WebLinkAboutPermit Electrical 2011-8-1
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? 0 Yes 0 No
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o Residential 0 Government Commercial
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Job site address:
City:
Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477.PH(541)726-3753.FAX(541)726-3689
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:
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Business name: I S f.! .. . - - . .
Address:
City:
Phone:
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Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
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440-2584-J (9/08/COM)
Residential, per unit, service include'd:
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) $ B1.00 $
20 I to 400 amps (2) $ 95.00 $
401 to 600 amps (2) $15B.oo $
60 I 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)
201 to 400 amps (2)
401 to 600 amps (2)
$ 63.00 $
$ B7.00 $
$126,00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per pane!
a. Fee for branch circuits with purchase ofa service or feeder fee:
Each branch circuit
$
b. Fee for branch circuits without purchase of a service or feeder fee:
First branch circuit (2)
Each additional branch circuit
Miscellaneous fees: service or feeder not included
Each pump or irrigation circle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel,
alteration, or extension (2)
Each additional inspection: (1)
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(A) Enter suhtotal of above fees
(Minimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [AD
(C) Technology Fee (5% of [AD
TOTAL fees and surcharges (A through C):
$ 63.00 $
$ 63.00 $
$ 63.00
$
$
$58.00
$
$
$
$
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 5t
Springfield, OR 97477
541-726-3753
INWW .d. springfield .or. us
811-5PR2011-01863
5094 MAIN 5T
permitcenter@ci.springfield.or.us
RECEIPT NO.: 2011002159 RECo.RD NO.: 811-SPR2011-01863 DATE: 08/01/2011
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Branch circuits with service ar feeder each circuit 224-00000-426102 54,00
Branch circuits withaut service ar feeder - 1st circuit 224-00000-426102 55,00
State af Oregan Surcharge (12% af applicable fees) 821-00000-215004 13.08
Technalagy fee (5% af permit tatal) 100-00000-425605 , ",_._.5,4,~
TOTAL DUE: 127.53
PAYMENT;;iiWREllIIIllmlllit~~iiA;;;:oR,'mmcAsHTER!IIII~eERllII~MMENjs_iIIil1!tilrn~mmm:~fM~P~lfiP,~I[j__i
Credit Card L YNNS ELECTRIC CO 127.53
03507C
To.TAL PAID:
127.53