HomeMy WebLinkAboutPermit Electrical 2019-09-06CITY OF SPIUNGFIELD, OITEGON
Electrical Perrni tA Iication
225 Fifln Strr.ttSpritrgfirtd, 0R 9?477 . Pll(5{ I )726-3X3. FAX(s.l I )?26-3689
l'his permit is issued
days of issuance or if
$or€: t'tt ,tq -ris-
0t**7. Loo 4 ta 3oo A s.-rvi4(_
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ci.^4-Llr-l-5 b bag\,rc-l( prr wtl r- .
under oAR 9t8-30g-0000. permits rre nontronsferabre. permias erpir€ if work is not stsrIGd within rg0$ork is susD€nded for 180 days.
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OEPARTMENT USE ONLY
Permit no -0005
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PROVALLLOCAERGOVMNAPENT FEE SCHEDULEZonint opproval verificd?! Yes Euo Nu nrbcr of insp..i ions p€r itc ( )Ql)Cost
et.Totel
coslCATEGoRYFoNScoRUTONcTt
E Residential Rcsid.nti.l, pcr unit, s.rric. iDcludedfl Govemnrent E Commercial
1,000 sq. li. or less (4)sr86.00 5ATSITJOBIEFORMANNTtoANDLOCtoNgg.,R...^L,li.^ B\., d Each additional 500 sq fl.orprrion
lh€rcol sJ6.0o
Cir Sare: 4P 7tP 9ztos l,irnircd€ner8) (2)s.11.00 $Reference:Taxlot.l,ach manufactu.ed home or moduhr
d\relling s€nicc or feeder (2)PTION OF WORK s89.00 $
S.nices or f€cdcr!: r) tallation, aherutiorr, reloe.ttion
20Q arnps or leis (2)j sl r2.00
201 to 400 amps (2)a sl3l.00 $
Name:401 1() 600 amps (2)s221.00 $
Address 601 to I,000 ainps (2)t s285.00 s,
Cnr,:State:Ovcr 1,000 amps or vohs(2)ZIP:s65J.00 :t
Phooe Reconnect onb. (2)Fax:s{r9.00 I
E-rnail:lemporrr) scrvic.s or fca(lcr\t irtstaltalio , a e
200 arnps or les.s (2)
s89.00 s
201 to 400 amps (2)$
401 !o 600 omps (2)s177.00 !
This
it
ProPc'I hisprop€rty
479.540(
n la lal be made trden atnll farm rttolvDedllemet)a be tby !n Dlnl ed fantalev )'
ts 0()ntende d for cxche,lca o l{an8e,
and -t9,l 56 0(
Signalure o rer 600 amps or I,0m volts, see sen.ices or fccders scction alrore
CONTR,ACTOR INSTALLATION Brrnrh circuirs:,rer, alte,alion. e\ten!ion
Business nante a. Fee for bralch circu ils wilh purchas€ of e service or fccder fec
Address (D I:arh brdnch circuit rl s8.00 $4
C Statet D4-ZIP: ?b. |cc for branch circuirs nithoul pnrchux ofa scnicc or fccrtcr fcc
Phone ['a\$
Il-nrail [ach addilional branoh circuil s{i.0t):i
CCB license no.:BCD license no.: /D ,i\liscllleoeous fecs: r?r1,ice or/ec.!cr not nrcluLd
nrng su isor's liceuse noS E{ch pump or inigolion cirulc (2)s89.00 s
Print name ofsignin g suPerv I:.ch sisn or ourtine tishrin8 (2)sE9.00 i
Signature of signing supervi miled{nerg} panel.II lr
rcr:rtion, or exrcfls;on (2)5li9-00 i
Erch rdditionrl iospttrion: )s 102.0{)s
DEPARTMENT USE
(A) llnler subknalofabolc fecs
(\liDinlum P.rmit I'c. St02.0{t)I
(B) Fnlcr 1296 surchrrse (. t2 r l^l)t
((')-Icchnolog) tcc (Sonof lAl)i
TOT^ L fces snd surcharges (A rhruugh D)
1-a5t cdiled 7/ln0l9 BJo[e$
?-c1 & B r^...^.-\aaA.d {-o crB +1
o
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Job site address:J
I
OWNER
5122.00
I irsr branch circuit (2)s8,).00
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