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HomeMy WebLinkAboutPermit Application 2013-11-18 02/07/2014 10: 37.- 50364"27925 GARNER ELECTRIC PAGE 01/01 Lr ?f r } �Its 4/ElecA-ppliea . DEPARTMENT USE ONLY 7 c F... .�, • -. i.,a.. .,s 7 SPRIt4GFIEL6 q f SI \�AC 0l 3-2 —J�- GTTY of �l'RI1�fGFIELM DREGOK Perinil no.: L.--• 1 225 Fifth Sneet•Springfield,OR 924774PH(541)726-37534FAX(S41)7263689 '-�a aborr . • Date: r — ' I 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 ISO days. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑No Number of inspections per item () Qty, Cost cootsal • CATEGORY OF CONSTRUCTION Residential,per unit,se Yice'htc111ded: ID ReSidentlel 111 Government ❑Commercial 1,000 sq.f r.or less(4) $147.$0 $ JOB SITE I--N�I1FORMATIONN, AND LOCATION Each additional S00 sq.ft.or portion Job site address: e�3 ' O O .V. y' y(�-7 thereof $ 27.50 $ City:J[iL'� Stare: 0. ZIP:d ! 7 !7 Limited energy(2) ! $ 35,00 $ • Reference: �1 Taxlot.: Each manufactured home or modular 5 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) • Services or feeders: installation,alteration,relocation 200 amps or less'(2) $ 88.00 s /� 'dam, OWNER 201 to 400 amps(2) $ 104.50 $ Name: Gla-, 60_I77 401 to 600 amps Y2(l 5174.00 $ Address: )_ 31""eff g p C5 601 to 1.000 amps(2) $225.60 $ City:"l/}rl��,r,t`t' State:oh( ZIP:67-71P7/ Over 1,00(1 amps or vole(2) - 551BAO $ I 11;b- 000 Fax: Reconnect only(2) S 69.00 $•Phone:rj� D - • Temporary services or feeders: insnillnrion,alteration.relocation E-mail: 200 amps or Icss:(21 $ 69.00 $ This installation is being made on residential or farm property owned by me or a member of my immediate family.This 201 t0 400 amps(2) $ 98.00 $ property is not intended for sale,exchange,lease, or rent.OAR 401 to 600 amps:(2) .$138,60 $ 479.540(1)and 479.560(1). Signature: Over 600 amps or 1.000 volts.see services or feeders section above CONTRACTOR INSTALLATION Branch circuits:.new olceranou.extension per poet! Business name: 9`- ' 1 / '.,0 a.Fee for branch circuits with purchase-of a service or feeder fee: Address' q2 p ,YE 0)0k Le P '1 �1�J�. r Each branch circuit J�I $ 6.60 $ City: fin No State:©R / /ZIP:q i23 b.Fcc for branch circuits withoul purchase of a service or feeder fee: • Phone:C lYi,,Oy� )-'��j F�az/./( W"f �� First branch circuit(2) $ 60.50 $ E-mail: ICL�r�C.h- A(�.i'r ' Q� Each additional branch cirniit $ 6.50 ,$ • CCB license no.: Ia.)I sq BCD I' ense •• , ,,c Miscellaneous fees:.service or,feeder not()lauded Signing supervisor's license no 1 .,,t,../ Each pump or irrigation circic(2) 5 69.00 $ L 'e` rdrx• . I�t 1.,' �� Each sign or outline lighting(2) $ 65.00 $ Print name of signing supervisor: 4 �2 a Signal circuit or a limited-energy panel, $ 80.00 $ Signature of signing supervisor: I vL 7a y,; WIC:7010n,or extension(2) 1 r,w,arty .•,u. , Each additional inspection:(I) $80.00 $ __ APPLICANT USE (A) Enter subtotal of above fees S (Minimum Permit Fee$80.00) (B)Enter 12%surcharge(.12 s(A)) $ • (C)Teclntology Fee(5%of[A)) $ 440-2564 4(4(0112017 IC08.4) TOTAL fees and surcharges(A through C): $ •