HomeMy WebLinkAboutBuilding Application 2013-7-18 Electrical Permit Application DEPARTMENTUSE ONLY
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?CITY ORSPRLNGFIELD OREGO - /
' 5a;,s € ,,gi rt. ?4:-.- �.+ sitek.t'> ,-41, ,,--:.k^ `«.. ,_ s . ^ Permit no.:J�J� (�p:��
225 Fifth Street♦Springfield,OR 97477♦PH(541)726-3753♦FAX(541)726-3689
Date: 7/i 9_,/
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. .
_a'dtLOCAL.,GOVERNMENTTAPPROVAL,- `"'T . ' ,:;?. t? k` "Z ' FEE.'SCHEDULEr ,x`','tVW's °
Zoning approval verified? ❑ Yes ❑No mr iptoem O' t eost t Total Nube of inspections, Qty: ,
:i:' t,'CATEGORYA;OFCONSTRUCTION,,,,';,-,t.,- - 3 .,`: Residential, per unit,service included:
❑Residential ❑ Government ❑Commercial
,,.,.. 1,000 sq.ft.or less(4) $147.50 $
�}? JOB�x SITE:INFORMATION ,ANOLOCATIOIJ^^; « s
Each additional 500 sq. ft.or portion
Job site address:n.200 11-0.4 It -*/ thereof - $ 27.50 $
City: inn,(fire( f State:0) L ZIP: a 7-Er 1-7 Limited energy(2) $ 35.00 $
Reference: ✓/7o I?6 vi Taxlot29'O/ Each manufactured home or modular
re r,,,,>-P,,„ *:yDESCRIPT ON tOF„',WORK m t gnt,Y..# mn. dwelling service or feeder(2) $ 69.00 $
2-e7 D ,s7- /a in/C-- - Services or feeders: installation, alteration,relocation
200 amps or less(2) / $ 89.00 $' -'?
a <t .4,:�`t b. ' ;PROPERTY OWNER f'',,t*„`w „ <_ µxi,?; 201 to 400 amps(2) $ 104.50 $
Name: tw/� 401 to 600 amps(2) $174.00 $
Address: -71-0 y S !62FN 5 ,'L v, 601 to 1,000 amps(2) $225.50 $
City: IA 5 State_ ZIP97f0( Over 1,000 amps or volts(2) $516.00 $
Phone: - - Fax: - - Reconnect only(2) $ 69.00. $
E-mail:
Temporary services or feeders: installation, alteration, relocation
200 amps or less(2) �/
This installation is being made on residential or farm property �`� a(�?--
owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 96.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1)and 479.5600). 401 to 600 amps(2) $138.50 $
Signature: Over 600 amps or 1,000 volts,see services or feeders section above
tel:*t` T?RitiCONTRACTOR„#INSTAEL'A iliO—N ':'F` 1.? is Branch circuits:new, alteration, extension per panel
Business name: Sit,)OP i-i U I, C�c-0 G a. Fee for branch circuits with purchase of a service or feeder fee:
Address: l Each branch circuit $ 6.50 $
City: State: ZIP: b.Fee for branch circuits without purchase of a service or feeder fee:
Phone: ( -go Y 4�p/ Fax: - - First branch circuit(2) $ 60.50 $
E-mail: s' �.-v/c,,,_e_j�� 4,_,c - co,....4- t, ! , co,___ Each additional branch circuit $ 6.50 $
CCB license no.:( 731/ L/ 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 iimited-energy panel, $ 80.00 $
alteration,or extension(2)
Each additional inspection:(1) $80.00 $
> a':9 macrAPPLInwUSEige' �r�f. F”
(A) Enter subtotal of above fees $
(Minimum Permit Fee$80.00) 2i
(B)Enter 12%surcharge(.12 x[A]) $ l0 i
(C)Technology Fee(5%of[A]) $ Yyr -
TOTAL fees and surcharges(A through C): $�C�13
440-2584-J(4/01/2013/C0M)