HomeMy WebLinkAboutPermit Electrical 2009-6-18
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I Date: ~'/ i flu 5 I
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if wo~k is not started within 180
days of issuance or if work is sllspended for 180 days. !,
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, ,1~_~H__-'-"____~"~~'," ,',"_"~i'l'L,"__'_'_d",___~.._J.,___".JjiMt!'~a;i!'l"",,,~=i( Residential, per unit, service included: I
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I City: <;i?r~l) I State: ()/?- I ZIP: 07't7') I I Limited energy (2) , $ 32,00 $ I
~OE$~GRII?,j1l10ElJ[0f,11NJ.~~~~~_ I ~~~~I~:'S~~~~~r~~ Fe~~:r(~)lOduI,,! $ 63.00 $ I
. ~', ~ .c.:,'L _ fl -, I Services of'feeders: installation, ali'eriJ/ion, relocation I
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'I 200 amps or less (2) $ 81,00 $ I
l~__!11~""'RR0B~l'{m:t"OWNER"'i'i'll:lI''''';'~~i<',~."'''''l I 201 to 400 amps(2) $ 95.00 $ ,I
I ::~Z::;;J #:.&.,::~~ ,"',~,'~.-~ 'dP.l"~1 I 401 to 600 amps (2) $158.00 $ I
I Address: :2 "" "3 >' "1) I. I 601 to 1,000 amps (2) $205.00 $ I
I City: Sf PL.I"::> I State: 0'12- I ZIP: '1 '7 Y '/')1 lOver 1,000 amps or volts (2) $469.00 $ I
I Phone: I Fax: . I I Reconnect only (2) " $ 83.00 $ I
I E-mail: I. I Temporary services or feeders: in~'tallation, alteration, relocation I
This installation is being made on residential or fann property I 200 amps or less (2) $ 63.00 $ I
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $ I
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1). . I 401 to 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 volts, see s~rvices or feeders section above
:~~!!;:0'l'Im~CiIL01~~IN$JlleiwI!A:l'iION~~~I~t;~~~ Branch circuits: new, alteration, extension per panel
Business name; R ,~_ E../ e.e I Rlc a. Fee for branch circuits with purchase of a service or feeder fee: .
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I Address: Po ih <s lJ 1- Each branch circuit I 2--1-$ ;6'00 I $)0 I
I City: C ~ E:..s: "';U' iJ I State: 0 (I. I ZIP: '9 7 <I a-L I b, Feefor branch circuits without p~rchase of a service or feeder fee: I
I Phone:S -<j -/ ~'H '/</&/./ Fax:" .-'1 -I '[19'; 'IlL-I. I First branch circuit (2) $ 55.00 $ I
I E-mail: Q.=...1~.rtK;.V<"@.fA1l1../.{.cd) I I Each additional branch circuit $ 6.00 $ I
I CCBlicenseno.: /7f.:; i:? I BCD license no,: (;,:5:3.5 I I Miscellaneousfees:serviceorfeed~rnotincluded ,I
I Signing supervisor's license no.: 2. 770 - S' I I Each pump or irrigation circle (2) Ii $ 63.00 $ I
I Print name of signing supervisor: {}./...J e. ,'p-:' II.J(, ,v> ' I Each sign or outline lighting (2) $ 63.00 $ I
I Signature of si,gning supervisor: dJ/r~ /J L:.-/ J_~~ -A . I Signal circuit or a limited-energy panel, $ 63.00 $
CJ!qc:.e? T ~~ "'-fl-' alteration, or extension (~)ii
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I Each additional inspection: (I) !! $58.00 I $
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(A) Enter subtotal ofabovefees I t/
(Minimum Permit Fee 558.00) 10 ~ $ JDi2--
(B) Enter 12% surcharge (.12 x [Am $ i~'
(C) Technology Fee (5% of [A]) $059- J
I TOTAL fees and surcharges (A through C): $' iJ-?E- I
Electrical Permit Application
225 Fifth Streel+Spriogfield, OR 97477+PH(541)726-3753+FAX(541)726-3689
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440-2584-J (9/08/COM)