HomeMy WebLinkAboutPermit Electrical 2019-09-12Tor 541126i689 tron: 541344 015 5
t9-0204
Electrical Permit A lication
Thlr pe.r8lt tr t$ued under OAR 9t&3094000. PcrElt* rre Dortrencf.rablc. PerEits ctpire lf work ir not lhrted s'llbltt 180
dr!6 of lssuioce or if tort ir crsperdrd for 180 dry3.
Fex
E-rt)3il
This instsllation is b€ing made oo residential or f6Im prop€ny
o$Ded by me ora mcntber ofmy imrnediate family, Tlia
propcrty is nol iotendcd for sale, ex.haogc, le€se, or rqfi. OAR
47 9.540(t ) utd 47 9.s6o(t ).
s
Busincss Eamc: Cootre.tors Elc.tric l.LC
Address: p6 96122233
t-r Eutepc Srate:6ty
Pl\orc: 511-341-2222
BCD Iicenfe no t9
Sigaing supervisor's licensc no 52I S
Print name ofsiguingsupervisor: fcfllr Broun
Si8natu-re of signing supcrvisor
Fermitoo.:811-19 t522-DWL
\4Date
LOCAL GOVEENITE T aPPEQv4-:
Zoning rpprovel verifiedt ! Yer D no
6 Residcotial E Govemment D CoEmercial
JOB SIYE INFOftMATION ANI
Job 6it addrc6s: 1232 S 69th Place
ciryi Springfield Stata: OR ztP 97478
TaJ(lotRcference
New home
i.\ame
Addrcss
City Stet
ZIP: 974n2
F6r:511-34+0155
CCB license no C6l I
EOU
Rc.idcBti.t pcr unlE t€rvlcc hcludcdl
sfi85.00l,(rco sq. R or less (4)
Bach 6dditioosl J00 5q i. or po(ion
6crcof s35.0{3
s4-{.00LrBitci cncrBy (2)
ss)-00 s
Sarvicd oa f€edeE: irntallntiok, oheration, ftloc4lion
20O amps or lcas (2)sr r2-00
113r.00 s20I to 400 alrps (2)
401 to 600 amps (2)s22r.00 3
601 to 1,000 &rps (2)t2ts.00
s654.00 5
Rc.onncct only (2)s89.00 $
TeEDorrry tervi..a or tsrde'rt installa.ion, alteration, r.locotba
200 amps or less (2)
201 to 4O0 erDps (2)s122.00 5
401 ro &0 snrys (2)
'l7?,00Ovcr 600 lrps or I,000 volts, sc. sen,iccs or fccdcrs scctioo aboye
EraEct circ[itaf ,ex,, a lleratioh, erlctltion pd pancl
r. Fcc for bnnch circuiE with purEhasc ofa s.rvicc or fc.d., fcc:
Erch bnncb circuit s8.00
b- Fee for brrr|ch circuits without punhrsc of. se^rce or fccder fcc
F;rst branch circuil (2)] sse.oo S
Frch addit on.l brsrcl c)rcuit s8.00 s
s89.00
F,sch sign or oudinc hBhting (2)38r.0rl
5
S
SigDa, circurt or s limjrcd+ncrg] pancl,
ehrntion, or ertcrEion (2)5
Escb rddidoE.l iEspccdos: (t)
sE9.00
5
ARTN'USEENI
(B) Irtcr l2% iurch.rge (.12 x [A l)
TOTAL fecs ard srrchsr8es (A rhrough D)i
s
t
$(C) T.shnoio8/ Fc. (5% of[A])
Lrst edir.d i/I/2019 BJsuco
225 Frtr Sn..r. Sertngfidd, OR 9t{??. PU(s,{r )7,GJ7J! . F^x{s,a r)7r65t9
9-12-19 3:l9Pr P. 2 of 2
DEPART'*EI{T I'3E Ot'lLY
Nrober of iBipi.fiotrs per itent ( )ary.
s
Each narufrctlrd homa or modular
dwcllirg Ervic€ or f€.dEr (2)
$
5
Ovcr 1,000 amps or volts (2)
$89.0{l
$
MhcellrEc{ur f.Gr: s€rvicc orfe2ler not includcr)
Each pump or irrig&tton circle (2)
sr02.0{
(A) Ent r suhtotsl ofabov€ f€cs
(Mloioull Permit I'ce tl02.0o)
s
roNCATEGOTY OF CONSTRUi
PF
ZlP:
Phonc:
:ONTRACTOR
E-rlail: Jrermits@contractorscl(ctri(11..(om