HomeMy WebLinkAboutPermit Electrical 2019-07-15S Electrical Permit Application
C IT Y O F SP R IN G F IE L D , O R E G O N
225 Fifth Streete Springfield, OR 97477 • PH(S41)726-3753t F AX(S41)726-3689
DEPARTMENT USE ONLY
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.
,ocAL:GOVERNMENT-APPROVAL- -· -~ ~':. :.. ? ,,; "_ FEE SCHEDULE
Zoning approval verified? n-- 0No """ Cost Total
CATEGORY Of· CONSTRUCTION - Number of Inspections per Item () , Qty. ea. cost
D Residential 1-K(Govemment I D Commercial
Residential, per unit, service Included:
~JOB SITE- INFORMATION AND LOCATION 1,000 sq. ft. or Jess (4) $186.00 $
Job site address: 0~C:- Por/", '<;· Each additional 500 sq. ft. or portion $36.00 $ thereof
<:: JI_/' /J I State: ri if. I ZIP:(} 7 c/7 7 City: Limited energy (2) $44.00 $
I I Tax.lot.:
.
Reference: Each manufactured home or modular
-DESCRIPTION OF WORK - - dwelling service or feeder (2) $89.00 $
-.
L J ,·..r.'/Ja ./2. - L _ -f- t. ,,,-,HJ ,.,,,, c::; Services or feeders: installation, alteration, relocation
I , , 200 amps or less (2) I $112.00 $
. - - . PROPERTY -OWNER ;_ 201 to 400 amps (2) $131.00 $ . ,i;)
Name: W ,"f/lL,,.,,_a/a ,,,_, 401 to 600 amps (2) $221.00 $
Address: 601 to 1,000 amps (2) $285.00 $
City: I State: I ZIP: Over 1,000 amps or volts (2) $654.00 $
Phone: - - I Fax: - - Reconnect only (2) $89.00 $
E-mail: Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property
200 amps or less (2) $89.00 $
owned by me or a member of my immediate family. This 20 I to 400 amps (2) $122.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1). 401 to 600 amps (2) $177.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
: - CONTRACTOR INSTALLATION - r>e..1:: '~-- Branch circuits: new, alteration, extension per panel -
Business name: LJ-r ~/4_J/-r,~I I IL a. Fee for branch circuits with purchase of a service or feeder fee:
~ I "?'7 -~ -
Address: vvl /J • ',,,, <; ;- Each branch circuit JDI ss.oo $
r - ,,, I( - I State: tJ/ I ZIP: q. 7 «sa City: b. Fee for branch circuits without purchase of a service or feeder fee:
Phone:W.fl-S-'9 it./.) I 1 Fax: - - First branch circuit (2) $89.00 $
E-mail: I V\v.P .A/) /,p,,1-¥"- ',. ~ q. LAC/'!r C -~ Each additional branch circuit $8.00 $
<../ T '1 / r Miscellaneous fees: service or feeder not included CCB license no.: aoo ~ J;. 7 BCD license no.: C 9 /,, ?-
Signing supervisor's license no.: _(,...J:10 O 5" Each pump or irrigation circle (2) $89.00 $
Print name of signing supervisor: ~ - ~~-A :j?.,. --Each sign or outline lighting (2) $102.00 $ -
Signature of signing supervisor: / / / j? /2z._ Signal circuit or a limited-energy panel, $102.00 $
/'
alteration, or extension (2)
Each additional inspection: (1) $102.00 $
' ,---~. " .- .,DEPARTMENT USE __ , ..,;_, ~ -
(A} Enter subtotal of above fees $
(Minimum Permit Fee $102.00)
(B) Enter 12% surcharge (.12 x [A]) $
(C) Technology Fee (5% of[A]) $
TOT AL fees and surcharges (A through D): $
Last edited 7/1/2019 B.Jones