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HomeMy WebLinkAboutPermit Electrical 2013-10-28 Electrical Permit Application DEPARTMENT USE ONLY SPRINGFIELD (J 51/0013- `/ �S SPR[NerdetI), OREGON ' td ' Permit no.: b 1I - 021g7 225 Fifth Street[Springfield.OR 97477•P11(541)726-3753•FAX(541)726-3689 :. ‘ OREGON ?? Date: P 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. [ LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item() Qty. Cost Total ea. cost CATEGORY OF CONSTRUCTION Residential,per unit,service included: ❑ Residential ❑Government id Commercial JOB SITE INFORMATION AND LOCATION OOO sq.R.or less(4) $147.50 S IJIJ c r' F-I J A 1/, el, Each additional 500 sq.0.or portion $ 27.50 $ Job site address: V thereof ) r_ City: G State: O,_ ZIP: q 7403 Limited energy(2) $ 35.00 $ Reference: ' 703 3Y 33 Taxlot.:C0700 Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) fan', Seitlice- �?r /- z-e Services or feeders: installation,alteration,relocation CO T(J DLO LEC 200 amps or less(2) $ 89.00 $ CON tra a4- 201 to 400 amps(2) $ 104.50 $ PROPERTY OWNER Name: Patti 1 ntSl1 4 kQ ry)#-C 401 to 600 amps(2) $174.00 $ Address:: I'S1 'fy5t ni 1 .1 SW/ 601 to 1,000 amps(2) $225.50 $ City: eUrn/) . State: 04 I ZIP: q '?4 cc Over 1,000 amps or volts(2) $516.00 $ Reconnect only(2) $ 69.00 $ Phone: Fax: - - E-mail. Temporary services or feeders: installation, alteration, relocation This installation is being made on residential or farm property 200 amps or less(2) ' $ 69.00 $49,60 owned by me or a member of niy immediate family.This 201 to 400 amps(2) $ 96.00 $ property is not intended for sale,exchange, lease,or rent.OAR 479.5400)and 479.5600). 401 to 600 amps(2) $138.50 $ Signature: • Over 600 amps or 1,000 volts,see services or feeders section above CONTRACTOR INSTALLATION Branch circuits:new alteration. extension per panel Business name: Pa.[f). CQf��t.,/.�� C IS.... )j _ /y1G a. Fee for branch circuits with purchase ofa service or feeder fee: Address: �/ Half '6t .P�(r(&/?rei Js, Each branch circuit $ 6.50 $ City: y[�j,t,� rDY State: Di ZIP: 9 ved b.Fee for branch circuits withom purchase ofa service or feeder fee: Phone:503 1St/0 1(e7( Fax:5b3769- spec, First branch circuit(2) $ 60.50 $ E-maiCpati.ffccOCtjte,leL-r/ic_Qt.t) y1.Cori Each additional branch circuit $ 6.50 $ CCB license no.: 99333 BCD license no.:074-19 At Miscellaneous fees:service or feeder not included Signing supervisor's license no.: 3GSs�S• Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor: b;el l� 'Z C Each sign or outline lighting(2) $ 69.00 $ Signature of signing supervisor: ��//�� � �� Signal circuit or a limited-energy panel, $ 80.00 $ signing P effy. t// �`L alteration,or extension(2) Each additional inspection:(1) $80.00 $ APPLICANT USE (A) Enter subtotal of above fees /T/ • (Minimum Permit Fee$80.00) $ fo, op (B)Enter 12%surcharge(.12 x[A]) $ 1%6 a (C)Technology Fee(5%uf[Al) $ '/ao/ 440-2584-J(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ q 3.6o