HomeMy WebLinkAboutPermit Electrical 2013-4-9 Apr . 09. 2013 ' 05 :23 AM COUNTRYSIDE 5419268822 PAGE. 1/ 3•
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DEPARTMENT USE ONLY
Electrical Permit Ap a lication /
SeHINGrIGI.P 5 i3 oa / L,..3
CITY OF SPRINGFIELD, OREGON Parma na.: .
US Ulnh Street Springfield,OR974n1 Pl(541)72637539FAx(5411726.,1659 Oecoon
Dale:
This permit Is issued under OAR 918-3119-0000. Permits are nontransferable. Permits expire if work is not started within ISO
days of Issuance or if work is suspended for ISO days. •
_ LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
9 No Number of Inspections per item O Qty ost..•1 cost)
Zoning approval verified. ❑Yes ❑ D P
CATEGORY OF CONSTRUCTION _. Residential,per unit,service Included:
❑ Residential ID Government k' Commercial
1,000 sq.R.or less(4) $147.60 T
JOB SITE INFORMATION AND LOCATION Each additional 500 sq.II.or ponion 5 27.60 $S
Job site Address'C.I I 1 I V AJ ">t' -... ..-. -1 thereof -.._...,_. _ _ .., ....-
Cil � I State:O ZIP:41 Limited energy(2) $ 35,00 $ _
Y. 1Lv c
t Tax lot.: Each manufactured home or modular $ 59.00 S
Rcfcl'e e: dwelling service or feeder(2)
DESCRIPTION OF WORK
!� 1 y Services or feeders: Installation, aIie,vliu t,relocaiun
`�iL ` c�l5� U` � •Y R 4
��vv 201 to 4r00rt less(2) $ 89.00 S
11� ��,�,, `1�tc6c.l
..._ Va� G O� �"VS'. -' amps(2) S 101.60 $
PROPERTY OWNER
401 to 600 amps(2) 5174.00 13 ,
Name: ... _... _. .. .__ _. 5226.60 $
601 to 1,000 amps(2)
Address: .,,_. — -- - $616.00 $
• — I State: I ZIP: Over 1,000 amps or volts(21
City: _.. Reconnect only(2) S 89.00 _... ....._.._
IFax: . -Phone: - _.._-- --- Temporary services or feeders: Instollnllnu, alteration,✓✓mention
E-mail: - 200 rm+ps or less(2) $ 89.00 5 -
This installation is being made on residential or farm properly _ .. _..
owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96,00 5
property is not intended for sale,exchange, lease,or rent.OAR ,101 to 600 amps(2) $138.80 $
479.540(1)and 479.560(1).
Over 600 amps or 1,000 Volts,see SerViecs or feeders section above
Signature: .. "'
CONTRACTOR INSTALLATION Branch circuits:newt alteration, extension per pwml _ T
1 a.Fee(or branch circuits with purchase of a service or feeder fee:
(v�•C Sid ��cGII __rC. Zw P
Business name: V '(',. .. t)1 .- _ ....
�,` r� Each branch circuit I $ 6.60 $
Address:�v?:r..at:. 3.2.1? ._ .-
State:O� I ZIPS 13 0 b.Fee for branch circuits without purchase of a service or feeder Ice:
City: Lyon ) .... _... - S 60.50 �J/���}a
✓Fax: - - - First branch cb'cuit(2) � $
Phone'. - 4 94 rl .. -I. _ 6.60 $ 0$
I ,Cl , .-.. C Each odditiomd branch circuit I $ ._
12-maifst., se .: t 1 Cki1S.�
Q Miscellaneous fees:service or feeder ml in<Loled
CCB license no.: y11y BCD license no,:�Jl(,O_ _• .._. -....- -
L15 Each pump or irrigation circle(2) $ 69.00 $
Signing supervisor's license no.: o�j .. • _ $ 69.00 $
Each sign or outline lighting(2)
-
Print name of signing supervisor: ht -0 eu_ .fit °
-- ] s Signal circuit m'a limited-energy panel, $ moo $
Signature of signing supervisor: a �I, ._ yA� ea1 allocution,or extusion(2) -. .
Each additional inspection:Cl) S80.00 $
APPLICANT USE -
(A) Enter subtotal of above fees 'ry OCD
(Minimum Permit Fee$80,00) if%.4
(B)tinter 12%surcharge(.12 5(A]) $ e,lLr-+�
(C)'fcelinology Fee(6%of(A]) _. - - . $ _`i a 00
4411-25544(.1/1111211 1 3/COM) . tail
2 k r u ��� 5u r VV
cAccA I ( 3 0 loo
Apr . 09. 2013 05 :23 AM COUNTRYSIDE 5419268822 PAGE. 2/ 3
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