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HomeMy WebLinkAboutPermit Electrical 2013-10-28 (2) Electrical Permit Application DEPARTMENT USE ONLY SPRINGFIELD CMS SPRANG ID D OO REGOO [V 1: _ g7I -,jP/{d(�13- 021 (7 Permit no.: 225 Fifth Street•Springndd,OR 97477•i'li(541)726-3753•FAX(54l)72636S9 �$OREGON Date: 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. t 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 0 Commercial 1,000 sq.ft.or less(4) $147.50 $ JOB SITE INFORMATION AND LOCATION W 5 1 1 fl1 '` /A 1 Vet. Each additional 500 sq. ft.or portion $ 27.50 S Job site address: '�[ thereof City: Cu(fgym- / State: OA. ZIP: 975403 Limited energy(2) $ 35.00 $ Reference: ' 703 3 CI 33 Taxlot.:(07Oa Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) «t- (; `Ia- r / �_p Services or feeders: installation, alteration,relocation CMS.tru�a/I LPG 200 amps or less(2) $ 89.00 $ W PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $ Name: Pa.±.t f Y Q_St' 4 Jp mitt 401 to 600 amps(2) $174.00 $ Address:: IFS kE ( .7 B/UI 601 to 1,000 amps(2) $225.50 $ City: YI l A � State: 04 I( ZIP: q 7403 Over 1,000 amps or volts(2) $516.00 $ V 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) i $ 69.00 $4,1,00 owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 96.00 $ property is not intended for sale,exchange,lease,or rent. OAR 479.540(1)and 479.560(1). 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: patif c . coast ,, I� it cnc. a. Fee for branch circuits with purchase of a service or feeder fee: Address: eN�, •E• -tint n .e- Each branch circuit $ 6.50 $ City: , Q,q"Wn State: Die ZIP: 9730 b.Fee for branch circuits without purchase of a service or feeder lee: Phone:, _q 9-'i f(e ?( Fax:93""3769- Hoe(o First branch circuit(2) $ 60.50 $ L- n E-mail: pa cie cto a s Le,le 'c_t to 14.CONS Each additional branch circuit $ 6.50 $ CCB license no.: /ice/33 BCD license no.: 2gl-j 9 A . Miscellaneous fees:service or feeder not included Signing supervisor's license no.: 3GS3S Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor: b(� �t, Each sign or outline lighting(2) $ 69.00 $ Signature of signing supervisor: �,' Signal circuit or a limited-energy panel, $ 80.00 $ Signature b P Ql'/{jj'i//)el alteration,or extension(2) Each additional inspection:(I) $80.00 $ APPLICANT USE (A) Enter subtotal of above fees (Nlinimmn $Permit Fee$80.00) MO (B)Enter 12%surcharge(.12 x[A]) $ (1,‘,0 (C)Technology Fee(5%of[A]) $ 4v 440-2584-1(4/01/2013/COM) TOTAL fees and surcharges(A through C): $ q3.60