HomeMy WebLinkAboutPermit Electrical 2011-8-8
Elect?ical Permit A lication
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225 Fiftb Strect+Spriogfitld, OR 97477+PH(541)726-375J+FAX(541)726-3689
DEPARTMENT USE ONLY
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Penn it no.: 5/1-0/ g !t'
~-~-/I
Date:
Tbis permit is issued under OAR 918-309-0000. Permits are nontransrerable. Permits expire irwork is not started witbin 180
days or issuance or irwork is suspended ror 180 days.
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? 0 Yes 0 No
CATEGORY OF CONSTRUCTION
City:
Reference:
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 intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1).
ZIP: '7 7f{ Jg
Signature:
Signing superVisor;s license no.:
r.' Print name of signing supervisor:
Signature of signing supervisor:
on laW requI .\.
,6:rrENTIO~: Oreg b the 0 egon Uti
folloW rules adopte1hJse rules ere set IO~
NO~~~~~~_~~~~~~1 ~ throui~~ ~~~:~~:G~
~090 '(au may obtell1 ~~fe' the telephOne {\ J
caliing the center~ (on Utility Notilice\101l\ ~V. \
number lor the.O~_~OO.332..2.344). ! \)J","
center IS 1.1\'
~
~
440.2584-J (9108/COM)
FEE SCHEDULE
Number of inspections per item () Qty. Cost Total
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 reeder (2) Services or (eeders: installalion. alteration, reloca/ion
200 amps or less (2) I $ 81.00 $ 'is I
20 I 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 sen-ices or feeders: instal/alion, alteration, relocation
200 amps or less (2) $ 83.00 $
20 I to 400 amps (2) $ 87.00 $
40 I 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 of a service or feeder fee:
Each branch circuit $6.001$
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 feeqer nqt !nc,l,U!!e41:,~'..
Ea m.m" c.rJrrigation circle (2) .r' I . --eq>, $
EllC .~. ~fh~~j:I\:':;c 'J..J\!ljI.JW $
Si ~r' t~~~f~1 JNE fQiloo $
alt~~~ ~Q IS imb .,
Ea~;.lJ.lid'~iw!\a . \000. . . $58.00 $
/-\," 'VV APPLICANT USE
(A) Enter suhtotal of above fees $ rf
(Mioimum Permit Fee $58.00)
(B) Enter 12% surcharge (.12 x [A]) $ 971-
(C) Technology Fee (5% of[AJ) $ lfD~
TOTAL rees and surcharges (A tbrougb C): $ 9'177
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SPRING. FIE~
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'--~ OW:EGON
www.ci.springfield.or.us
TRANSACTION RECEIPT
811-5PR2011-01838
1275 30TH 5T
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
541-726-3753
pe rmitcenter@ci.springfield.or.us
RECEIPT NO: 2011002212
IDE5CRI~TION
Permit Fee Adjustment - Electrical
Permit Fee Adjustment - State Surcharge
Permit Fee Adjustment - Tech Fee
RECORD NO: 811-SPR2011-01838
. ACCOUNT-CODE
224.00000426102
821-00000.215004
100-00000425605
TOTAL DUE:
DATE: 08/08/2011
.AMOUNT.D.UE
81.00
9.72
4.05
94.77
AMOUNT PAID
I
ell. Yj\I1ENLTY)~!'~e!:l YOR CASHIER: OSOWLSSY
Credit Card michael gowins
008328
... COMII'[E~:rS
94.77
TOTAL PAID:
94.77