HomeMy WebLinkAboutPermit Electrical 2014-3-25 (2) Electrical Permit Application DEPARTMENT:.NSE ONLY i
,, .` .„, i -,i, '.rr I `4+ e- n ,,ca .aC TYf t„ PRINGFIELD; OREGON ) ..
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225 Fifth Street•Springfield,OR 97477•P11(541)726 3753•FAX(541)726-3689 -
Date: S tZ j //q
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.
cJjriMxsL`OCAL,','IGOVERNMENT'?AP,FR'OVAL- f" : `., _ = r s' It nz€ek,1�-1"-,;FEECH ED U LEhVi, it xK
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9 L r t :-- t,yat x§d i z1 +;Oo5t (Total
Zoning approval verified. ❑ Yes ❑No Number of Inspections,per Item O Qty 1 's,ea s -cost.'.c
` ' :CATEGORYt:OF, CONSTRUCTION ^ ,,k ` de
Residential, per unit,service included:
Kesidential El Government El Commercial
1,000 sq.ft. or less(4) $147.50 $
r0. `JOBcSIT ;1N FORMATION-AND;=LOC ION;;;r_.,,,'.
Each additional 500 sq. ft.or portion
Job site address: Cat) Mr/4//�J 442: thereof - $ 27.50 $
City:%p -Jr� JQ 7 State'�rM, ZIl'Z , e Limited energy(2) $ 35.00 $
Reference i 1-� —I1 -m/9'VPaxlot Each manufactured home or modular
,.- Sa,,st?t,vS�)Y`�iD C'IRTION 'OF;'WORK`; s^ k '.•-d:^ �' dwelling service or feeder(2) $ 69.00 $
_ S M ..� J;a..}
�J / .�/1 O. /�/ �� e I Services or feeders: installation, alteration,relocation
• �/� • s^ _tr or i 200 amps or less(2) $ 89.00 $
.; +,; -yP_O `„ TY„O ER '" ,`)'q a' 201 to 400 amps(2) . $ 104.50 $
Name: ' G ' /Pr�`r t„ , I T 401 to 600 amps(2) $174.00 $
Address:f U O q� 7 /`t�et!-Q�/ x 601 to 1,000 amps(2) $225.50 $
City: ` State: 6t, ZIPf Over 1,000 amps or volts(2) $516.00 $
Phone/ Q68r 129 Fax:
t- Reconnect only(2) $ 69.00 $
E-mail: ein4r /'' / C net)
Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property 200 amps or less(2) $ 69.00 $
owned by me or a member of my immediate family. This 201 to 400 amps(2) 5 96.00 $
property o Mended for ale exchange, lease, or rent. OAR
479.54 1) 479.5 (1f 401 to 600 amps(2) $138.50 $
Signa re Over 600 amps or 1,000 volts,see services or feeders section above
�:4't': x''.`'i`. cONTRACTO^R 1NNSTALLATI. , ) r�','',? tZ415-;„`^,'. Branch circuits:new alteration, extension per panel
Business name:���,V 6 " - a. Fee for branch circuits with purchase of a service or feeder fee:
Address: Each branch circuit $ 6.50 $
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: - - Fax: - - First branch circuit(2) $ 60.50 $
E-mail: . Each additional branch circuit - $ 6.50 $
CCB license no.: BCD license no.: Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: , Each pump or irrigation circle(2) $ 69.00 $
Print name of signing supervisor: Each sign or outline lighting(2) $ 69.00 $
Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 $
. alteration,or extension(2)
Each additional inspection:(I) _ $80.00 $
t'+':h r' - +y x5 4PPLICANT Till SE x`+ ; . ,li', `<'
. (A) Enter subtotal of above fees $\
(Minimum Permit Fee$80.00)
(B)Enter 12%surcharge(.12 x[A]) $O 0-
(C)Technology Fee(5%of[Al)' $ ((((((14 0,9
TOTAL fees and surcharges(A through C): $ q3SS1-
440-2584-1(4/01/2013/COM)
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http://spifs047/mapserver2013/mapviewerajax/quickplotpreviewinner.aspx 3/25/2014