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HomeMy WebLinkAboutPermit Electrical 2013-5-10 (2) DEPARTxMENT USE`nONLY Electrical Permit Application y SPa,r�FIE�o ' � t l3"- .? a" �^.,r�,, i...awt!sa '3F.-: ,c r,.�-*`y� . r3 a,,, w-` ° r g r s 93 _00 �� eCITY�,FmSPR�INGFIEI D, OREGONf `„ Permit no.: 225 Fifth Streets•Springfield,OR 97477•PH(541)726-37530 FAX(541)726-3689 Date: Ste' D 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. LOCL GOVERNMENTIAPPROVAL " R T` ?'t;�F E EtFSC HEDULE : F i „tt Zoning approval verified? ❑Yes ❑No 415.V ,4.t �toZ„ tQt ' Cost:= > Totae Numb of inpechonp t ro O ''''et ' coshd _ CATEGORY 'OF"CONSTRUCTIOV ri ' , � Y. , _ , Residential,per unit,service included: ❑Residential ❑Govemment ❑Commercial 1,000 sq.ft.or less(4) $14250 $ "JOB SIT.ESINFORMQTION KAND ,LOCATION °mss Each additional 500 sq.ft.or portion $ 27 50 $ ` Al thereof Job site address: Oil/ .s i $ 35.00 $ , + ZIP a 03 Limited energy(2) Reference 03 O]3 ZO Taxlot. OO ( 90 Each manufactured home or modular $ 69.00 $ F „�xf1 £,.,�. s dwelling service or feeder(2) ; �)DESCRIPTION OF WORK , j K . s ` Services or feeders: installation, alteration,relocation A L 200 amps or less(2) 3 '1 $ 89.00 �7 9• �' et-eV �,.. .; s^ +v . 201 to 400 amps(2) - $ 104.50 $ 4( t'p'01.;rif-aP . ___ . t" .)' ''.MaMM-.3:E:au _ $174..0 $ I�;;� �.�u. s ��„ ,ROPERTtYi,OWNER r<r<.�+�= n 401 to 600 amps(2) � _ Name: Asp ..� - r ` 601 to 1,000 amps(2) 5225.50 $ Address: ©6100 ., Au Ay Over 1,000 amps or volts(2) $516.00 $ Z1P: � $ 69.00 $ Reconnect only(2) Phone: - - Fax: - - Temporary services or feeders: installation, alteration, relocation - E-mail: 200 amps or less(2) $ 69.00 $ This installation is being made on residential or farm property $ 69.00 $ owned by me or a member of my immediate family. This 201 to 400 amps(2) $t 96.00 $ property is not intended for sale,exchange, lease, or rent. OAR 401 to 600 amps(2) 479.540(1)and 479.560(1). 401 to 600 amps amps(2) volts,see services or feeders 3 .50tion above Signature: 4, c Branch circuits:new alteration, extension per panel -�`CQNTRQTOR�,INSTALLAT,IONw� ,: t t � a.Fee for branch circuits with purchase of a service or feeder fee: Business name: A RA/5 �-� ----- Each branch circuit Gr $ 6.50 $ ��� Address: , V ZIP: b.Fee for branch circuits without purchase of a service or feeder fee: r First branch circuit(2) $ 60.50 $ Phone: - - Fax: - Each additional branch circuit $ 6.50 S E-mail: Miscellaneous fees:service or feeder not included CCB license no.: BCD license no.: $ 69.00 $ Each pump or irrigation circle(2) Signing supervisor's license no.: $ 69.00 $ Each sign or outline lighting(2) Print name of signing supervisor: Signal circuit or a limited-energy panel, - $ 80.00 $ Signature of signing supervisor: alteration,or extension(2) Each additional inspection:(I) $80.00 $ •a MOXIIC'fICOIT a SExr: r F^ • (A) Enter subtotal of above fees $�+rA? (Minimum Permit Fee$80.00) U�6 (B)Enter 12%surcharge(.12 x(A]) - $ )o 60 (C)Technology Fee(5%of[A]) $ H1'11140 TOTAL fees and surcharges(A through C): $ (010,22 iiy At) Q({� 7 Zt3 . 10 2-i3% 440-2584-I(4/01/2013/C0M) TOT,q„1 ' ri,/ ' /i