HomeMy WebLinkAboutPermit Electrical 2020-01-16Electrical Permit A tion
225 Pifth Strctt.springlitld, OR 97477oPII(541)726J753oFN((541)726'3649
This permlt is issued unrler OAR 9lt'30'-0000' Permlts rre nontransforrble' Permits explre if work is not strrted within 180
dsys bfissuance or ifwork ls sucpended for 180 days'
cCITY ()F SI'RIN(;FI I.]LD, OITEC;ON pu,m;tno'P-@o0 lb't
Date:b \2Di\r
E Governmcnt E Commercial
No
Residential $$186.00
verified? f]Yos
1,000 ft, or less (4)
Rosidontlel, pcr unit' gewice lncluded:
$$!6.00
$44.00 $
Each addirional 500 sq. ft, or ponion
thcrc0fJob site address;
ia
ZP:Limited errcrgy (2)
s$t9.00Each manufecturtd home or modular
dwelling service or feeder (2)Ta:dot.
$
Scwicos or fccileret lnstallation, alteration, docalion
s1r2.00200 arnps or lcss (2)
sr31.00201 to 400 amps (2)
Thie instelletion is being made on residential or farm property
owned by me er a momber of my immediate family. This
property is not intended for sale, exchange, lease, or rent. OAR
479.540(l) and a79.560(l ).
State:ZIP:
$177.00 $
Over 1,000 or volts (2)
Name;
Address:
E.mail:Tcmporrra gerryiceg or fcedors: in$talldilor., alten ion, relocation
Over 600 amps or 1,000 voltr, scc scrvice$ or feeders seodon above
$200 amps or less (2)
$201 to 400 amps (2)
401 to 600 amps (2)
$221.00401 to 600 arnpn (2)
$285.00601to 1,000 amps (2)
s6s4.00
$E9.00Reconncct only (2)
Phone:Fax:
Erench clrcultl: n*t, ahemtion, exlension per ponel
Business name:QC-,g. Fee for broflch circuirs with purchase of a &rvice or feeder fee:
$8.00 $Each brmch cfcuitAddress: lBtlC
)ZIP:b. Fee for branch circuits wittrout purohasc oft service or feeder feelCity: t TYt nt t state: f)[
$89.00 sFirst branch oircuit (2)ptrone#[l-Q6-1 R+IR
BCD license no.:
$
$
$
s
$E.00Bech addftional branch cirouit
Migccllancoue fwsl semice or/eeder not lncfuded
$09.00Each pump or irrigation cirole (2)
$t9.00sign or outline lishtins (2)
$rr.00
CCB license no.: l)
license no.:
Print name of si$ing supervisor:
Signature ofsigning
(A) Entor subtol{ ef p[eve fees
(Ivlinimum Permit Foo $102.00)
Erch edditioncl intpcction: (l)
r ll2,
$$lo2,oo
$ 13.+l(B) Enmr 12% surchuge (.12 x [A])
$ 4.(aD(C) Teohnologr ree (6% of [AJ)
sTOTAL fees and surcharges (A throueh D):
Lart cditcd 7/l/2019 EJonec
b
State6(-
$ lr?-fr
$
$
sCiR:
$
$89.00
s122.00
Sisnature:
tin \nn -ttE-mail: Ol
Signal citcuit or a limited-encxgy puel,
alteration, or extcnsion (2)