HomeMy WebLinkAboutPermit Electrical 2019-11-085 Electrical Permit A ation
225 Fifth Srreet.Springfietd, oR 97477.pH(541)726-3753. FAX(541 )726-3689
This permit is issued under OAR 9f 8-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days ofissuance or ifwork is suspended for 180 days.
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LOCAL GOVERNMENT APPROVAL
Zoning approval verified? E yes E No
CATEGORY OF CONSTRUCTION
! Residential I Govemment Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: n>O
City:State Zrc
n"f"relcB' LY Taxlot.:
DESCRIPTION OF WORK
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OWNER
Name:
Address
City:State ZIP
Phone:Fax:
E-mail
This installation is being made on residential or farm property
owned by me or a member of my immediate family. This
plgpgrty is not intended for sale, exchange, lease, or rent. OAR
479 .540(t) and 479.560(l). -
Signature:
CONTRACTOR INSTALLATION
Business name:,e I €/rcl,",-
Address:7d Eax yf I
City: ft+yeL-q State: d (,ztP:7 7/%vu*ffi,(-rrz_tfrl Fax:
E-mail:d -e/ec ((
CCB license no.: C / Y 6 BCD license no.: 223416
Signature of signing supervisor: /=
FEE SCHEDULE
Number of inspections per item ( )Qty.Cost
ea.
Total
cost
Residential, per unit, service included:
1,000 sq. ft. or less (4)$r 86.00 $
Each additional 500 sq. ft. orportion
thereof $36.00 $
Limited energy (2)s44.00 $
Each manufactured home or modular
dwelling service or feeder (2)$89.00 $
Services or feeders: iilstal lation, alteration, relocation
200 amps or less (2)$t 12.00 $
201 to 400 amps (2)$13r.00 $
401 to 600 amps (2)$221.00 $
601 to 1,000 amps (2)$285.00 $
Over 1,000 amps or volts (2)$6s4.00 $
Reconnect only (2)$89.00 S
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)$E9.00 $
201 to 400 amps (2)$122.00 $
401 to 600 amps (2)$177.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase ofa service or feeder fee
Each branch circuit $8.00 $
b. Fee for branch circuits without purchase ofa service or feeder fee:
First branch circuit (2)$89.00 $
Each additional branch circuit $8.00 $
Miscellaneous fees: sentice or feeder not included
Each pump or irrigation circle (2)$89.00 $
Each sign or outline lighting (2)$89.00 $
Signal circuit or a limited-energy panel,
alteration, or extension (2)$89.00 $
Each additional inspection: (l)$r 02.00 $
DEPARTMENT USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $102.00)$
(B) Enter l2oZ surcharge (.12 x [A])$
(C) Technology Fee (5% of[A])$
TOTAL fees and surcharges (A through D):$
DEPARTMENT USE ONLY
Permirno.: \q- tlO llo5t{
Date: lt l0 lzotl
Last edited 7/1/2019 BJones
CITY OF SPRINGFIELD, OREGON
Signing supervisor's license ""., / l0/ 5
Print name of signing supervisor, C LnS D"r-l
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