HomeMy WebLinkAboutBuilding Application 2014-2-13 .
Electrical Permit Application DEPARTMENT USE ONLY
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Mme' -3 :.s:::: ast.la•� ••b`y °i..�,..sa; `.. . „ _ "" c°:.. Permit no.: f......
4.-.?"E 13 v
225 Firth Stints Springfield,OR 97177♦en(541r72f3753+FAx(s41)76-3683 ltd vA-oPEGOer --_
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L Uate._ 2I/ // Y .
This permit is issued under OAR 9f8-3®-0000.Permits are nontransferable. Permits expire if work is not started within ISO
days of issuance or if wort: is suspended for 180 days.
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LOCAL GOVERNMENT APPROVAL ! ---
---------- i FEE SCHEDULE
%cling approval verified^ Q Yes 0 No Number of inspections per item() Qt , Cost Total
_ CATEGORY OF CONSTRUCTION L yI__en_ I cost
-- Residential,per unit,service included:
al-Residential I ❑Government 0 Commercial
---- SITE --- 1,000 sq.Ff.or Icss(4) 3147.59 I 5
JOB S.TE WFOP,MATION AND LOCATION
Each additional 500 sq.it or portion
Jab site address: q' r
—__ L1�� . � thereof $ 2i.50 j S
city,-5' ,�/� j State: Cr,`. ZIP: 7 f/7f Limited enerzy(2) � -----j _.-
$ 35,00 1
Reieren Tn.etnt.: Each mmwG<lured home or modtdar I --_
�-s DESCRIPTION OF WORK
dwelling service or icedcr(2) $ 69.00 5
J -) 7 „ l -- ' Services or feeders:installation.alteration,relocation
U _ 2(ID amps or less(21 __ i $ 89.0D $
_ PROqP_ERTY OWNER 201 to 400 amps(2) s <a s0 S
-Name: m/ ____._ !}.� 401 to 600 amps(2)
__.--- _k_.._._i_e-L_ i $174.00 S
Address: �l yV —_ 6(11 to 1,000 mops(2) 5225.50 S
City: Jf 4 _, Stele: TZIPS7y72 over i Mil amps or volis(2) - _.- S516.00 S
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Phone: - rJ Reconnect only(2) $ 69,un S
L--!nail: - -- Temporary serefces or feeders:en.unllorwn alr,: u/ue, relocorfm,
This installation is being made on residential ar faro property
:00 amps or less(21 $ 69.00 $
owned'by me or a memher of my immediate family.This t 201 to 400 amps 2)
property is not intended for sale,exchange,lease,or rent.OAR. p (� 5 96.00_ S
479.540(1)and 429.560(0. 2 i __.__.__.-_.._..
( ), 401 to 600 amps[ ) I 5738.50 _ _-.__-_I
Sig _.__-
nature: Orr 600 amps or 1,000 Wits.see'Sell ices ur frecen seetioullxne
I CONTRACTOR INSTALLATION ' Branch eii suits:new tiltoratiott.etreasirn p,••priori ---..
�Busincss name k S6/e.ce v� .ait�l �- . a.Tee lot hronch circuit:with purchase of it service or(cede, (u:
Address: 7, a. /,',,x, 9.3 3 __ Each Srand7 circuit J
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City: C Z=2__. I State_0 I ZIP:9 i Yv Z b. Fee for branch circuits with:nil purchase of a service or feeder fee:
Pllolle:✓4-' TG '(A 3 c Fax: 5 /- �f' a (2) 6 60.50 I 5
J_ �`,5 ��%� I Pirst branch circuit( I
E-mail: fC w.z;% �• -� .Cs:,_:4�C^� —__ I I $ 8.5017S---
_50 $ —
Lea �' Each additional branch circuit
CCB license n P y M , BCD Iicen .S0- /\ Dliscelimreoos fees:service ra'/eeeler oar htepgG( --� --- •
Signing supery is. '_ t sense. o._ 3 �/ & Each plump or ini_aliun circle 12) I $ 69.00 }
Print name of signing supervisor: AZij,-4- 1J _ccA r Each sign or cut line liehtine(2) x" 69.00-_� ._-_ -_
Signature of signing supervisor: s ( J ' Signal circuit or ivnil:d-energy panel,
__-I uheratiuq or extension(2)..,_ — 580.00 $
I �t Each additional inspection:(1) $30.00
i/J i s?',K c'2G1/ 3 — U/ 3C APPLICANT USE
(A) Enter subtotal of above Ctes
(Minimum Permit Fee 580.00) t
(L])Enter 13::,surcharge(.12,.(`l;___.
(C:)Techno!ugy Fee(5%of(A1) --- 5
4J0'.SSi-J(stn tr^_0;;!C'o,1n• I TOT.tL fees arid surcharges(A.through C): -.--..
MI 0/76( S
L'd £L9P 886 lb9 OR110313 Ski e00A1 In £l 9e3 •