Loading...
HomeMy WebLinkAboutBuilding Application 2013-10-30 02/13/2014 6:40 PM FAX 5413575180 GARNER ELECTRIC Z0001/0001 Electrical Permit Application DEPARTMENT USE ONLY w •r1\ 1 , n a"l^,.,r r $ N¢ q wl x�rv, -�qp) I,^ „ l RGFiELD Auf �F r„ , l. i: N •A Yl c,1� a ) ,1 smrr ... n t,,p, ,),4f4adai: 1 r, : Permit no.:5,7 225 fifth SlrcteSprhrelid<I,OR 97J77•PN(5J1)726J753•[A\(SI)726.3689 " °` OXAOON / / /7 Date:/Q / rV/� x This permit is issued under OAR 9I8-3094o00. Permits arc nontransferable. Permits expire if work is not started within 180 days of issuance or if work Is suspended for 180 days. LOCAL GOVERNMENT APPROVAL T' L FEE SCHEDULE Zoning approval verified? D Yes ❑NO CATEGORY OF CONSTRUCTION Number of Inspections per item O Qty. Cost Toost tal rs Residential Residential,per unit,service included: Government [ ❑Commercial - _ JOB SITE INFORMATION AND LOCATION 1.000 sq�l1.or(ex (4) 5147.50 (t/). , — Job site address: 7( �� c• -- Each additionaI 500 srl.iL or portion Job cLk $s�Trl?Y�j Ihellor $ 27.50 $ 53 City; �t fIt Store: rC ZIP: $ 36.00 $ - i� L 1_imimC ener8y(2) _Reference: TTaxlol.;;73 Each munnlacutted borne or modular DESCRIPTION OF WORK dwelling service orteeder(2) •$ 69.00 $ I `Yu S c C�/ f f JN�' ---^- Services or(ceders:installation, alteration,relocation — ^200 amps or Icss(2) ~^�- $ 89.00 $ _ n PROPERTY OWNER �_ 201 to 400 amps(2) $ 104.60 $ Name: /4 0 fun BA SC Oho 401 to 600 imps(2) $174.00 $ — Address: - . 601 to 1,000 amps(2) _______$226.50 $ .J City: Stale: ZIP; Over 1,000 amps or volts(2) $516.00 $ Phone: - - [ 1':ax: - - .�~ Reconnectonly(2) s 69.00 $ IS-mail: —"— Temporary services or feeders:installation. allrr0110n, relocation Phis installation is being made on residential or farm property 200 maps or less(2) ' owned by me or a member of my immediate family. This 201�w 4UU amps(2) S 96.�' A_� eG '• $ property is not intended for sale,exchanger lease,Or rent. OAR 00 § 470.540(I)and 479.550(1). 40I to 600 amps(2) —" $138,60 Signature: Over(i0U naps or 1,000 volts.sec services or feeders section above •,__CONTRACTOR/5I`N�SrTALLATION Branch circuits:tint.alteration,extension per panel B U$Illess name: GA�I,g1 Q�'C /_ foC T- a. Fcc for branch circuits with purchase.ol'n service or feeder fec; A fires : <SV Re t /7 UC Eatch branch circuh l 1 $ 6,50 $ City: r•.U Cl ip le C [ Slate: Q Zip:9?f o� h,Fee Mr branch circuits without puRbase ors service or(ceder fcc: shone:S /- $/f! 357 —.� �yl. O Ia, [ fra<: 5/$Q rust hnmch ciranit(z) S 60,60 S E-mail: '� ! j it w't n''ZCQi,;tl �J Virir(l,•t f ¢!• Each additional branch c rcuit $ 6.50 l' YC iCrCQ/vl _ _ CCB license no.: I2I'/5 i $(D license no.: 39• 3 01 G Miscellaneous fees:se nice orferdrtr not included �_- Signing supervisor's license no.: _• 757p 7. s Each pump or irrigation circle(2) S 58.00 $ _ Print name of signing supervisor; c h C✓r C,a j,Uc�/i' Each sign or outline lighting(2) $ 69.00 $ �- Signature of signing sttpervisot �,�/�-,��_ Signal circuit of nlimited-energy panel, $�"- (((LLL"' akrnition,s,r t�tcnsion(Z) $ 80.00 Each additional impaction:(I) $80.00 $ _•�• APPLICANT USE (A) Enteranbintnl of above fees (Minimum Permit Fee$30.00) F i70� (13)Enrer 12%surcharge(.12 x(A]) $d;y qC (Cl)`I'echnolQBv FFee(PA,of(A)) • •�-$ // 440.2534-161/01/2013/CONO ur TOTAL fces and surcharges(A throu gh C 2(S7 i