HomeMy WebLinkAboutPermit Electrical 2019-01-10crTY oF SPRINGFIELD, OREGON
Electrical Permit A Iication
225 Fiflh Str..t.Spriosficld, OR 97477. PII(541)726-37s3. FAx ( 541)726,1689
This pcrmit 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 E No
CATEGORY OF CONSTRUCTION
n Residential ! Government E Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 801 42ND ST
City: SPRINGFIELD State: OR ZtP:97478
Reference Ta\lot.:
DESCRIPTION OF WORK
UNDERGROUND INSPECTiON
PROPERTY OWNER
Name; IP EAT THREE LLC
Address: PO BOX 2118
City; MEMPHIS State: TN zrp:38101
Phone Fax
E-mail
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
47 9 .s 40(1) and 47 9 ,560(t) .
Signature:
CONTRACTOR INSTALLATION
Business name: OLSSON INDUSTRIAL ELECTRIC INC
Address: 1919 LAURA STREET
CiTY: SPRINGFIELD State: OR ZIP:97477
Phone: 54t 747 8460 Fa-x: 54) 747 4846
E-mail: DOUG.HEER@OLSSONELEC.COM
CCB license no.: 63473 BCD license no.: 20 24lC
Signing supervisor's license no.: 3334S
Print name ofsigning supervisor DOUGLAS HEER
&
FEE SCHEDULE
Number ofirspections per item ( )Qty Cost
ea.
Rcsidential, per unit, service included:
$
Each additional 500 sq. ft. or poftion
thereof $ 33.00 $
Limited energy (2)$ 41.00 s
Each manufactured home or modular
dwelling service or feeder (2)s 81.00 s
Services or feeders: inslallation, aherution, relocation
200 amps or less (2)s r03.00 5
201 to 400 amps (2)s120.00 s
s203.00 5
601 to 1,000 amps (2)s251.00 $
Over 1,000 amps or volts (2)$599.00 5
Reconnect only (2)s
'l'emporary services or feedersi inslallation, altetation, relocation
200 amps or less (2)$ 81.00 $
201 to 400 amps (2)$ 111.00 $
$162.00 s
Over 600 amps or 1,000 volts, see services or feeders seclion above
Brench circuits: r?9r, aherulioh, extension per panel
Each branch circuit $ 7.00 $
b. Fee for branch circuits without purchase ofa service or leeder fee
First branch circuit (2)$ 81.00 s
Each additional branch circuit $ 7.00 s
Miscelloneous fees: renice orfeeder not included
Ilach pump or irrigation circle (2)S
Each sign or outline lighting (2)s 93.00
Signal circuit or a limited-energy panel,
alteration, or extension (2)$ 93.00 s
llach additional inspe.tion: (l)I s93.00 $93
DEPARTMENT USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $93.00)vfit
(B) Enter l27o surcharge (.12 x [A])$ u.t6
(C) Technology Fee (5% of[A])s 4.65
(D) Conlinuing Education Fee $2.50 s2.50
TOTAL fecs and surcharges (A through D):$ u-rfItfoTUN-- t1Y
DEPARTMENT USE ONLY
re,mirno.:f( -ffYbl ;V
Date D
Last cditrd 5-5-5-2017 BJones
Signature of signing supervisor:
Total
cost
1,000 sq. ft. or less (4)$17 t.00
401 to 600 anps (2)
s 81.00
401 to 600 amps (2)
a. Fee for branch circuits with purchase ofa service or feeder fee:
s 81.00
$
H