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):