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HomeMy WebLinkAboutPermit Electrical 2019-01-22CITY OF SPRINGFIELD, OREGON Electrical Permit A lication DEPARTMENT USE ONLY I ol3o DLPermit no :25 Fifth Strect. Springficld. OR 974:7. PH(5.{ I )726-37 53 . fAx(541 )726-3689 Date This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire af work is Dot started t ithin 180 days of issuaoce or if work is susperded for I80 days, LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verifi ed? , CATEGORY OF CONSTRUCTION Residential. per utril. service itrcluded:I Commercial srer.oo ] sJOB SITE INFORMATION AND LOCATION ,Each addjrional 500 sq. ft. or portion thereof L State ,, ZIP: Q 7 -? 7: Limited energy (2)I s s.oo Taxlot aL Each manufactured home or modular dwellinE sewice or feeder (1)lsas.ooisESCRIPTION OF WORK Sel.vtces or fe€ders: insraliation. aheratioh. reiocation 'es e_ 5r- PROPERTY OWNER Dxo idential ' D Govemment Job site address o Refere 1.000 sq. ft or less (4) 3 lt.r.* | t r$ 200 arnps or less (: ) 201 to 400 amps (:) s 109.00 s127.00 s2,t5.00 I l3 Name dciress: / t Cin: J 5s-ctI 401 to 600 amps (:l S 601 to 1.000 amps (2)s277.00 s 200 amps or iess (2) s 118.00 s 401 lo 600 amps (?)s172.00 Over 600 amps or 1.000 vohs. see se^,ices or feeders section above Srare ) q77 Over 1.000 al0ps or vol$ (2)s535.00 S E-4t b o/,F ax:.f y1 -7 (7 " r 32 Reconnect only (2.1 s 86.00 s E-mail *t ,n ,u,nr€ c-o* t Q-tna, 1- co.r--n Temporarl ser.rices or l*derst mstallation aherarion. lelocafion 5 E6.OO S zlP This instailation is b"i.rg -ud. on ,"rid*ti!l - fu.,n prop"rq' owned bl me or a member of m1 imrnediate famill. This properq,is not iltended for sale. exchange. iease. or rent. OAR 479--i40( I rand 479.5601 I r.i.-> Srsnature: 4< CONTRACTOR INSTALLATION Branch circuits: nev, alteratton. ettension per panei Address Crtr L a. Fee for branch circuits with purchase ofa service or feeder fee Each branch circuir s z.rzls Fir$ branch circurt (ll s 86.00 s Each additional branch clrcu,l s7.42,S Srate Phone -tct,'7 a-\ q b. Fee for branch circuits without purchase ofa service or feeder fee:zlP I CCB iicense no.: I q 7 LL 1 BCD lic"ns. no v zTz:-7I / )a^Miscellaneous lees: rer,rice or:feeder not included si O5gning supervisor's license ncr Print name ofsrgning superuso! Siglature of signrng supervi Each pump or irrigation circle (:l s 85.00 5 Ea.h sun or outiine lighrmg (: )s 99.00 S Signal circuit or a limited-energl panel I alt€ration. or exlension (:)s 99.00 s Each sdditioual inspection: ( I r s99.0c 5 DEPARTMENT USE (Ar Enter subtotalofabove fees (MiDiDxum Permit Fee S99.00) (BlEnter l2olo surcharge (.12 x [A])s s Lrsr edited 7/t,'20r6 BJones 201 to 400 amps (2) I Numberof inspectioD. p€r itcd ( , lqrr'.i g I *:t, crl: I Phone: Business name E-mail: (C) TechDolo$ Fee (59o oflAl)s TOTAL fees and surcharges (A througfi D):