HomeMy WebLinkAboutPermit Electrical 2009-3-16
Electrical Permit Application
225 Fifth Strect.Springfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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Permilno: '. 0017/
I Date: 3- Ib - ZaD ( I
This permit is issned nnder OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180
days of issuance or if work is snspended for 180 days.
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II rl $ 6,00 I $ K flO
,b. Fee for branch circuits without purchase ofaseryice or feed€r fee: I
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. ---I Each additional inspection: (I) $58,00 $ I
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I (A) Enter subtotal of above fees $ \...., I
(Minimum Permit Fee $58.00) {
'I (B) Enter 12% surcharge (.12x [A]) $ '?O.;;l
I (C) Technology Fee (5% of [A]) $ 8~r
I TOTAL fees and sureharges (A through C): $ 1 p,~
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1 Zoning approval verified? 0 Yes 0 No 1
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1 '~Residential I D Government I D Commercial 'I
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I Job site address: '{ 7 ']. I ::T<~s In, !<.d 1
I City: S'")'~I'L~(.,>Jj, IState:0r !ZIP:Q'747'& I
ISnbdivis{on: I 'iJOl obI J' 1 Lot no,: D "} SODI
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I Name:.
I Address:
I City:
I Phone:
1 E-mail:
This installation is being made on residential or farm property
owned by me or a membe~ of my immediate family, This
property is not intended for sale, exchange, lease, or rent OAR
479.540(1) and 479.560(1),
0,>"", is C~'iJeic.t
37 '11 ::rMfF7t ~
'S. ~F-A I State: csIL 1 ZIP: 97f.{7g
IFu: 1
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Signature:
1'1"'?;l~~-'e'0NiP~C:IiORtl-INSirAIfIiA,(:10N-,.!i'''''kl>:'''::~-!!:i;'1
WJt'l:t!t~~j;L. _ .l........'_____"''_}_ _ _, _ 1" ,_, _ _, w.1\7!';lfuti:w~+~-_,-,,"'*!,
1 Business name: A- ;ZAP g "-~~n~:
1 Address: ~~ C~"r'~-r!" DY'
I City: <;':-V-,MCJl r State: C).- 1 ZIP:977'7'3'
1 Phone:54i-5>S::"7223 1 Fu:~~.e.
J E-mail: t .d(~l~~':'+iM":' ^ A) (-....,.)Inc..b<'.+ _~ V\e.f-
1 CCB license no.: J'i? )"b3~1 BCD license no.: 2' '3i.s
I Signing supervisor's license no.: 4e,.IM.J2.
I Print name of signing supervisor: 0 J.J. 0' (')"'. -I-m.~ "
I Signature of signing supervisor: Wti.LJ1L,,~
440-2584-) (9/08/C01
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I Residential, per unit,service included:
1,000 sq. ft, or less (4)
Each additional 500 sq. ft. or portion
thereof
1 Li";ited energy (2)
I Each manufactured home or modular
dwelling service or feeder (2)
I Services or feeders: installation, alteration, relocation
1 200 amps or less (2) I $ 81.00 $f!:J
I 20 I to 400 amps (2) $ 95,00 $
I 40] to 600 amps (2) $158,00 $
I 601 to 1,000 amps (2), $205,00 $
lOver 1,000 amps or volts (2) $489.00 $
I Reconnect only (2) $ 63,00 $
I T.emporary services or feeders: installation, alteration, relocation
I 200 amps or less (2) $ 63,00 $
I 20] to 400 amps (2) $ 87,00 $
1 40 I to 600 amps (2) $126,00 $
lOver 600 amps or 1,000 volts, see services or feeders section above
I Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase ofa service or feeder fee:
$134.00
$
$ 25,00
$
$ 32.00
$
$ 83.00
$
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Each branch circuit
First branch circuit (2)
$ 55.00 .~
$
Each additional branch circuit
$ 6;00
~iscellaneous fees: service or feeder not included
I Each pump or irrigation circle (2) $ 63.00
I Each sign or outline lighting (2) $ 63,00
I Signal circuit or a limited.energy' panel,
$ 63,00
alteration, or extension (2)
$
$
$