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HomeMy WebLinkAboutBuilding Application 2014-4-28 Electrical Permit Application DEPARTMENT USE ONLY 'f'"' '' SPRINGFIELD CITY,OF S fttSit it i ,OREGON ?/l-SPRdo/y-• .- 1? -. rz • .x _y. ._- _ Permit no: 225 Fifth Streel•Spring0eld,OR 97477•l'H(541)726-3753.FA\(541)726-34169 °"`°H oo790 Date: 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. LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑Yes ❑No ^Number of inspections per item() !Qty.! Cost I TOtal ,,��`` CATEGORY OF CONSTRUCTION ca. cost y�tcesidential Residential,per unit,service included: ❑Government I ❑Commercial 1,000 s q.n.or lass 4 O JOB SITE INFORMATION AND LOCATION 5147.50 $ Job site address: _" df0 A. w'�--1 Each additional 500 se.0.or portion thereof $ 27.50 $ City:„J.- • State ZIP: # Limited energy(2) $ 35.00 $ Refere• c: Taxlot.: Each manufactured home or modular DESCRIPTION OF WORK dwelling service or feeder(2) $ 69,00 S Services or feeders:installation,alteration.relocation ' 200 amps or less(2) I $ 89.00 $ � _� MPROPERTY OWNER 201 to400 amps(2) $ 104.50 S Name: ION'.. t► yoga\e it- 401 to 600 amps(2) $174.00 S - -Address O n, cocr --) 601 to 1,000 amps(2) $225.50 $ City (ct 1 State©_ I ZIP9yef.791 Over 1,000 amps orvolts(2) $516.00 $ Phone I Fax: - . Reconnect only(2) $ 69.00 $ 6.1118i144MS ik _1a �. m-f-• 'se:I Temporary services or feeders:installation.alteration.relocation - This installation is being made on residential or farm property 200 amps or less(2) $ 69.00 s owned by me or a member of my immediate family.This 201 to 400 amps(2) property is not intended for sale,exchange,lease,or rent.OAR $ $6,00 479.540(1)and 479.560(1). 401 to 600 amps(2) $138.50 $ Signature: Over 600 amps or 1.000 volts,see services or feeders section above CONTRACTOR INSTALLATION Branch circuits:arm afelatlot.extension per panel Business name: Gm D Elei ` ac_, a.Fee for branch circuits with purchase of a service or feeder ice: 91 w"Address: - „it ��.C7TP I Each branch circuit $ 6,50 I $ City: (I Stater„_ ZIP9,WS b.Fee for branch circuits without purchase of a service or feeder fee: Phone - (1 79 Fnx'Stiff 9PS•ya0) First brunch circuit(2) $ 60.50 I $ E-mail,,, i..�..��. /,�'/'�,'y" r •c�d Each additional branch circuit $ 6.60 S CC:.tt�nsc PO. BCD license no.'7 1iscehaneous fees:service or feeder not included Signing supervisor's license no.: K274/..s Each pump or irrigation circle(2) $ 69.00 $ Print name of signing superv•. .r I Coo esk .�da a Each sign or outline lighting(2) $ 69,00 S Signature of signing I) Signal Signal circuit or limited energy panel, amnion.or extension(2) $ 60.00 $ a Each additional Inspection;(I) $80.00 $ 9\ohs a` 0 . t) APPLICANT USE (A) Enter subtotal of above feu �1 • `ZI - L • (Minimum Permit Fee 580.00) S r (B)Enter 12%surcharge(.12 x[Al) $ - Ikavi f� (C)Technology Fee(5%of(A]) $ 440-2554.1(4101/2013/COM) rte••• I TOTAL fees and surcharges(A through C): $ pc :cpCJ Z is # 9LGC Zc(t5:o1 :Woad!Nd9Z:ao t(-9 -to GMD Electric Inc. We Do It the Better Way P.O.Box 72206 Springfield,OR 97475 Phone: 541 741-7369 Fax:541 988-1800 Email:gmd @gmdelectric.com CCB 162191 FAX COVER SHEET TO: Chris FROM: Sue© FAX: 541 726-3676 PAGES: 2 RE: 811-5PR2014-00790 DATE: 04/28/14 340 N.66th Hi Chris: Attached is our application to change the current permit to GMD Electric. Thanks so much! Have a super day. S© \ ot • "(tt s /C/ Z /t # 9L9EELl179 01 w0a2'Wd9Z:Z0"vl-8Z-t0