HomeMy WebLinkAboutBuilding Application 2013-10-30 02/13/2014 6:40 PM FAX 5413575180 GARNER ELECTRIC Z0001/0001
Electrical Permit Application DEPARTMENT USE ONLY
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: Permit no.:5,7 225 fifth SlrcteSprhrelid<I,OR 97J77•PN(5J1)726J753•[A\(SI)726.3689 " °`
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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/). ,
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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 $
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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 $
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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 $
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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