HomeMy WebLinkAboutPermit Electrical 2014-08-2208-22-14;12:29PM;From: To:5417263676 # 2/ 2
Electrical Permit Application
CIO SPRINGIg
QLD, OGOl�T
.r:....
DEPART MENT USE ONLY
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
Zoning approval verified? ® Yes C] No
CATEGORY OF CONSTRUCTION
esidenttal 10 Oovenunont I ❑ Commercial
JOB SITE INFORMATION AND LOCATION
dab silo address: �1�C.% -
City; It , stat0 P ZIP; `P
Rofarenc ;
Taxlot.:
DESCRIPTION OF WORK
G e-
PGQPERTY OWNER
Name:
Address: o
City;
ZIPC%;?j'7
_sta
Phone; Fax: - -
E-mail:
This installation Is being made on residential or form property
owned by me or a member of my immediate family. This
property is not Intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479,560(1).
Signature:
CONTRACTOR INSTALLATION
Business name: amz
Address;
Cit st4gf, I Zip: 7
Phon to Fax5'44 CI&S-14106
Email: sv0�e�e� Cts . ersa -- 0
CCB lie sc no.: ° f
SCD license no,: "a2J
Signing supervisor's license no.: P7,
Print name ofsign• supervis • ,z6 ( lc;Ks
Sigttmur tin sup tvis
C11i•� .
1.
�m4i
•
440-25844 (410112013/COM)
— FEE SCHEDULE
Number of inspections per item (
Qty,
- Cost
Coal
Tota)
cost
RoAdontial, per unit, service inchrdodr
1,000,5q. ft. or Icss (4)
$147.60
S
Each additional 500 sq, 11. or portion
thereof
-$-29.60-
—S
_
Limited energy (2) _-.
S 35.00
S
Each monuracturedhomaormodular
dwelling service or feeder (2)
5 60.00
fi
Services or fecdersl hufallollon, alleraUon, relocation
200 amps or less (2)
$ 68,00
S
201 to 400 amps (2)
$ 104.50
$
401 to 600 amps (2)
$174.00
S
601 to 1,000 amps(2)
$22.5.60
$�
Ovcr1.000amps orvolts (2)
8690.00
S
Reeonneat only (2)
S 59.00
$ _
Temporary services or f90orsi lnstolludon, alteration, mlocallon
200 amps or loss (2)
$ 69.00
S
201 to 400 amps (2)
$ 95,00
1 S
<I01 to 600 amps (2)
$938.60 1
S
Ovcr 600 amps or 1,000 volts, tte services or tccdors section above
Branch circidtsi nervi alleeallon, estenslon perlmnel
a, Fee for branch circuits with purchase of a service or Iccdcr No;
Each branch circuit $ 6.50
1 S
b. Fce for branch cireoits without purchase of a scrviec or feeder fee;
First branch circtdt(2)
S 80.60
$
Each additional brunch circuit
$ 6.50
$
Misecihmeous fees:.service or feeder not included
Each pump or irrigation circle (2)
1 F 59,00
$
uaoli sign or outline lighting (2)
5 09.00
S
.Signal circuit ora limited -energy panel.
alterotion, or extension (2)
S 80.00
S
Each additional inspection: (1)
$80.00
S
APPLICANT USE
(A) Enter subtotal ol'above tees
(Minimum Permit Pee $80.00)
$ 7
�)
(B) F",ntcr 12%surchrage (.I2 x tA])
y
(C)TcchnologyFne(S%of(AP
5 y�
TOTAL fees and surcharges (A through C):
$ 9 i
08-22-14;12:29PM;From:
M Electric Inc.
We Do It the Bemr Way
To:5417263676 # 1/ 2
P.O. Box 72205
Springfield, OR 97475
Phone: 541741-7,369
Pax: 641 988.1800
Email: gmd@gmdelecidc.com
CCB 162191
TO: Chris FROM: Sue:
FAX: 541726.3676 PAGES: 1
RE: SP14.01467 (490 24th) DATE: 08/2214
Add GMD to permit
Hi Chris:
Attached is the permit that we would like to have GMD added to as the Electrical
Contractor.
Thanks so much! Have a terrific weekend.
Sue@