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HomeMy WebLinkAboutPermit Electrical 2020-01-08Pe itA lication 22s Frfth Stt.etaSprl nffldd. ()R n4n.?n(y I )726-J?St. t.AX($4t )?2{r.16tt9 OEPARTMEHT USE OiILY FEE SCHEOULE t"lql!-lg n"r", I B[;o i This permlr is days of lrruen b J:'"'"T, :X1il,3*,[:il-#l*1ffi Iiff n- t rc n o n I ra n rre ra hr e' Pe r m I t LOCAL GOVE RNMENT APPROVALZonlngapproval verified?I Ycs I tto \rrrnlrr r of inspr'tlionr p(r ltr m ( I ()l)' lCATEGORYOFCONSTRUCTION Rerldentirl, per unlt' rrvice locluded:Residential CrovcTnmcnt D Commerciat C!.tta.I TotrlI cmt _lc:JOB SITE INFORMATION I,tX)0 sq. ft. or less (4) g""n "aaitio*t 500 sq. ft' or portion I lslS5io i 3 AND LOCATIO N l*.*Job site oq ila Citl J.*q thcreof Limitcd encrgY (2) Temporery servlces or fcederg: installation, wM ls S ZIP Taxlot Each manufactured home or modular lt.r.* a"'iiling scruice or feeder (2) Servlces or feeders: inslallation, alleration, relocalion sr 12.00 $131.00 s221.00 s285.00 $5s4.00 s sRc t OESCRIPTION OF WORK s s ( okeraion. relxatian i s89-00 s89.00 ssq.0r) SThis installation is being made on residential or farm prope4y owned by me or a mcmber of my immediate family. This properry- is not intendcd for sale, exchange, lease, or rent. OAR 479.s40(t ) and 479.560(1 ). Signature Business name S fiSsuwfv iror's license no. Print name of Sign*we of signing suPcrvisor s122-oo I s s177.00 Over 600 arrys or 1,000 volts, see servics or feeden section abore Bnnch circuits: new, alteration, *ension per patel a. Fee for branch circuits with purchase of a service or feeder fee: st.00 b. Fee for branch circuis without prmhasc of a service or f:,ods fee: S s ai Miscrllrncous fecs'. service orfedo rct il'c/rldt:d s Signal circuit or a limitrrl-encrgtr punel allcrotion. or cxtcnsion (l ) Erch rddltlonrl lnspcctioo: ( I ) 1A) lrntcr suhtotul rll {ho\c lt('s (lltlulnrunr I'rrmlt !'crl tl0f.0$) PROPERW OWNER State: Namc Ad&ess Ci AP Phone Fax: E-mail CONTRACTOR INSTALLATION Address State:C FaxP E-mail BCDCC:B licenxno. 200 amps or less (2) 20, !o400arngs(2) 401 to 600 arPs (2) 601 to 1.000 amPs (2) Over 1,000 amPs or vols (2) Reconnect only (2) 200 amps or less (2) 201 to zl00 amps (2) 401 to 600 amps (2) First branch circuit (2) Each branch circuit Each additional branch circuit Each pump or irrigation circle (2) s8.00 SSe.00 $${.mEach sigrr or outline lighting (2)\ 5$1.00 i $ltr"e lttt 7lltrfr 19 None* l( ) I \l lr'r:r anrj a ) ti lltl:nr "upur,,'l \or: a I a4 n I) I I I nc e-