HomeMy WebLinkAboutPermit Electrical 2020-02-24Electri cal Permit A tion
225Fifth Streeto Springfield,OR97477.pil(s4t )726-3753o FN<(541)726-3659
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This permit is issued under OAR 9lg_309_0000. permitsdays of issuance or if work t, ,*p.ri.a i*jl"o orrr.
are nontransferable. Permits expire if work is not started within lg0
CITY OF SPRINGF,IELD, OREGON
DEPARTMENT USE ONL Y
53q-Permit no.11-
Date:>D
APPROVALLOCALGOVERNMENT
Zoning approval verifi ed?flYes nNo
CA TEG o RY OF
! Government ! Commercial
JOB SITE N AND TIONLOCA
Job site address:8 5 C
City:State:ZIP:
Taxlot.
DESCRIPTION OF WORK
PROPE RTY OWNER
Name:
Address:
City:State ZIP:
Phone:Fax:
E-mail
CONTRACTOR INSTALLATION
Business name c-e
Address rtt
City:ZIP:
Fax:
E-mail:
CCB license no.:ll oa BCD license no.
s license no.: Ll55rl S
Print name of signing supervisor: Dgn i/n
Signature of signing
FEE SCHEDUL E
Number of inspections per item ( )Qty Cost
ea.
Total
cost
Residential, per unit, service included:
1,000 sq. ft. or less (4)$r86.00 $
Each additional
thereof
500 sq. ft. orportion
$36.00 s
Limited energy (2)$44.00 $
Each manufacfured home or modular
orservlce feederdwelling (2)$89.00 $
Services or feeders: installation, alteration, relocation
200 amps or less (2)$l r2.00 $
201 to 400 amps (2)$r31.00 $
401 to 600 amps (2)$221.00 $
601 to 1,000 amps (2)$28s.00 $
Over I.000 amps or volts (2)$654.00 s
Reconnect only (2)$89.00 $
Temporary services or feeders: ittstallation, alteration. relocation
200 amps or less (2)$89.00 $
$122.00 $
401 to 600 amps (2)$177.00 $
Over 600 amps or 1,000 volts, see services or feeders section above
Branch circuits: nan, 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)t $89.00
Each additional branch circuit $8.00
Miscellaneous fees: service orfeeder not included
Each purnp or irrigation circle (2)$89.00 $
Each sign or outline lighting (2)$89.00 $
Signal circuit or a limitcd-cncrgy panel,
alteration, or extension (2)$89.00 $
Each additional inspection: (1)$102.00 $
USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $102.00)
sp{
(B) Enter 12%o surcharge (.12 x [A])$
$(C) Technology Fee (5% of [A])
s L'2-.TOTAL fees and surcharges (A through D):
Lest edited lll/2019 BJones\
Signature:
State:6 1l
201 to 400 amps (2)
$8q
/,a-$ l[a