HomeMy WebLinkAboutPermit Electrical 2009-3-12
225 Fifth Street+Springfield, OR 97477t PH(541)726-3753t FAX(54 1)726-3689
....P...R.~.'.N..a .....a. . .... 1':~9E,PARTffl~!'I~ USE ONLY
L~ A'" I (.OM WO? <? -u
~.~. Permit no.: Olo,s-,
- I Date: 5!~ '7
I
Electrical Permit Application
\ erry dF SFRINGFiBILD;ciOOG0N '
.,' , _ _ :::-' T
This permit is issued under OAR 918-309-0000. Permits are nontransferahle. Permits expire if work is not started within 180
days of issuance or if work is suspended for 180 days.
I 'LOCAL GOVERNMENT APPROVAL, . 1 FEE SCHEDULE
Zoning approval verified? 0 Yes 0 No 1.I'!D:"'berof'."" . ,':.ns peritefu () IQty.l. ~
I CATEGORY"OF CONSTRUCTION' I
J Residential, per unit,service included:
lIE Residential I 0 Government j 0 Comme;cial _n_1 I ( I
11,000 sq. ft or less (4) $t34 00 $134
1 '0 ;JOB SITE INFORMATION AND lOCATION . 1 ' .
I Job site address: crof So......S€! De. I I ~~~~:fditionaI500 sq. ft. or portion 13 I $ 25,00 $ 7S':
ICity:5'n,,,,("I-"/lS<..!) IState:o.l1... IZlP:'17477 I I Limited energy (2) I 1$32.00 $
1..SUbdiviSion:. '. I Lot no.:.. ..1 I Each manufactured homc or modular 1 1 $
L .'" "q'.DESCRlPTlONOF WORK'" :. '~~~I dwelling service or feeder (2) 63.00 $.
I Z 1./57:),F RB/ik,,'/J EL~L c".,.,pl..:itCJ-...I, I Services or feeders: installation, alteration, relocation
I I I 200 amps or less (2) $ 81,00 $
,~,,:;:;'~P.ROPERTY'OWNER '"",1 I 201 to 400 amps (2) $ 95.00 $
I Name: ~WI& ~.e.e-;t'N A-iI I I 401 to 600 amps (2) $158.00 $
I Address: z,80 I G re:l:N I~ J:~ 160110 1,000 amps (2) .. $205,00 $
I City: l;:l)J::rt:'Nt:: ,I Stai.;: cXL J~~~~~over1,00QampsorVOltS(2) I I $469.00 I $
I Phone: ~ I - C? Il-ISlS 71 fiji.!\O<'~~ ~e O~: ~,e S - ClQ'Jl.eeonneetonly (2) I I $ 63.00 I $
E-mail: -.~WV' ...,y.. ~~e() \.I J e ~,....-O~~ ~ asj'qimporary serv~ces or feede~s: installation, alt~ration, relocation
This installation is ~8" ~~~~j~~~al}~~~\~~ \O~'!~ amps or less (2) '$ 63.00 . $
owned b~ me or a m ~"'(iffiM~mi6'o~~e \e '1' c~fi to 400 amps (2) $ 8700 $
property IS not mten ~~::-l~, .'V~"Oi\.~O\~" .
479.540(1) and 479.\&1 . I:f.j ~'lO~\e" ~'r.~~\~.y.r." 1401 to 600 amps (2) $126.00 $
~~~;:_~r~~,,' _. ~. ~~ ~ ~~ rr~e~O.C;':i:."~. ..,"' . lOver 600 .amps or 1,000 VOlts,. see services or feeders section above
I~-; ""$:~:,,,.CONTRA . ~T1~-~ 4"'" ',e, . . I I Branch .Clreults: new, allerallan, exlenswn per panel
J Business name: C2A....I~_IL I ._1 a,. Fee for branch circuits with purchase of~ service?f feeder fee:
I Address: Po 13oJ' S'3S;i?4~:(:;;;L" ... I I Each branch circuit I $ 6.00 I $
I City: ,c;.j)'\"'170,...J -;', State: o'L I ZIP: q 7 J 1Jj I I b. Fee for branch circuits withl?ut purchase ofa service or feeder fee:
I Phone:$Ol-x'7-ft>o' I Fax:9l3':t1-.>Od'f I I First branch circuit (2) .1 1 $.55.001 $
I E-mail: . [ r Each additional branch circuit ., ,$ 6.00 $
I CCB license no,: Si,,, 't I BCD lIcense no.. Z'-!-, 47'- I I Miscellaneous fees: service or feeder n5t ,included
I Signing supervisor's license no.: 272.0 S I Each pum.p...~gation ~~'C;~.) I "t. I $ 63.00
I Print name of signing supervisor: '-"L.L/iII.... r ~A~IJ I > EaehSlgn9U)~thnel,'illt'\ng.\~~i\ 1$63.00
I Signature of signing supervis . iA~ <>t ~ 1"1 Signal circuit or\'l:~il<..d~eJgy panel, 1 1 $ 63.00 $
or. alteralion, ?(,,6.o<Jel\.Slq~:(2:\C\'0
Eac~ "IIlii;!~'(llf~R@i),n: (I) . I I $58.00 $
m;~~*ifP.i!fCANT.lIb~"''iW u.;."'''"~J
. ~~. ~'\ \~~~'l1~~tbt)tal of above :ees
~\.I;\'\'\ <>~<:0 ~~. J(Min"f/Dunt,"'"-mit Fee $58.00)
\....v S" :-C' ~ ~ ^,';J"'" .
. '\~ :~,:~\J<:0 ~t(13i~n(t"Y2% surcharge (.12 x [AD
~\::, '0~~\ \(~\Technology Fee (5% of[AD . 'I
\.l ~..J., '\ TOTAL fees and surcharges (A tbl"ough C):
\" ,
~<-.
Total
cost
$
$
1-
.,.
$ZD~
$ 2.f.cl
$ /0,0.-1"-
$ZJiL/.s3
440-2584-J (9108ICOM)