HomeMy WebLinkAboutPermit Electrical 2009-9-2
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Electrical Permit App ication .
225 Fifth Street+Spri'.lgficld, OR 97477.PH(541)726~3753.FAX(541)726-3689
I penni(no,:e~- ()\ \$2{)
I Date: q,ry_'Oq
.This permitis issued under OAR 918-309-0000. Permits are nontransferable;' Permits expire if work is' not started within 180
days of issuance o~ if work is suspended for 180 days.
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0\ (\() 5~_ D~ .\e.{'('U'S 'I I ~~~v::;sO:rf;::,e;;; instal/atian. alleralian,rela~at~:~~o $ i
c,WroP.:rl'>c, Dn,\If' -< ~y______ " '" I 1201 400 '( I
I::tPf'fi;'l01lli~itZlli~~t%j011jrt~RO~ERty-:zKo.WNER:illfu~Jt~~'iY~~;~1i1 to . amps, 2) $ 95.00 $
I Name: 0\\ A N".D\~ \...\.C-. I 1401 to 600 amps (2) $158.00 I $ I
I Address:~(J~D><.\ ?l"l1-0 I 160Itol,000amps(2) $205.00 I $ I
I City: f~f\a.- r State: o a.. I zlp:Ch4D\ I 1 Over 1,000 amps or volts (2) $469.00 I $ I
I Phone: ' ' I Fax: I 'I Recoooect only (22 $ 63.00,1 $ I
1 Ii,
E-mail: ITempo~al1;seryicesOrfeeders:ii1~tallation.alteration.re.location-
Th" II' . b 'd c 1 200 am" p.s or. Ics,s (2) $' 63.00' '$ I
IS msta atlOn IS emg ma e on residential or lanTI property
owned by me or a member of my immediate family. This 1 201 to 400 m~ps(2)' $ 87.00' $ I
property is not intended for sale, exchange, lease, or rent. OAR I
479.540(1) and 479.560(1). ' I 40 I to 600 amps (2) $126.00 $
Signature_: lOver 600 amps'or 1,000 volts, see s~rvices or feeders section above I
IRj;';'''':,c':.:'':1)![COf\lTRACTClR~INSTAl!C:A''IClNlh:L~i',':~:':lij:lI I Branch circuits: new. alteration, e:,lensian per panel I
I I Business nam~: WI j din r: Li:?(k.. ('~ I 1 u. Fee for branch circuits with purc~'ase. ofa service or feeder fee: I
,I Address: /q, YJ1~t"OVl' I I Each branch circuit I $ 6.00 I $
I City: f:Ub;..b1-.I State:_'oR" I zlP:tf!7'10Z I I b. Fee for branch circuits without p~rch~se ofaservice or feeder fee:
I Phone:"'" I Fax: I I First branch circuit (2) I $ 55.00 I $
, E-maj];--. I Each additional branch circuit' I $ 6.00 -I $
I CCB Jicense no.: '/c.9 L I BCD license no.: 'ZtJ-/2 C r Miscellaneous fees: service or ftetl,~r not included
I Signing supervisor's license no.: 527'5" S 'I Each pump or irrigation circle (2) $ 63.00
I Print name of signing supervisor: RlJS5 Ea!bL, s I Each sign or outline lighting (2) l $ 63.00
I Signatureof,'signi_ngsu.pervj,sor: j./), 5' /7 /- ~ I Signal circuit or, 'a limited~energy panel, $ 63.00
I ~ / vv- alteration, or extension (2) _
Each additional inspection: (1)
,';i~ ~~
',:::.' &'~V\\" C\,~D~
, ~ - \D' ..~ctR
\<)-' " ~ ~
6.\4..01 / \0J:if\-C\tt ~
1'~:o/;~.:!::;l'~3t:LoCAL:Jj-.G:OVERNMENT~AF.!F.!~OYAI.;;J'i;,,"i:e..;,::-;";1
I Zoning approval verified? 0 Yes 0 No I
Ii''',','~. iZ''''''''''C A"T EG'ORyiiO"ifCO'NSTRU'CT'IO'N'7.;'!>;4-"i{' ""'-"
"'1 \'" -!$;{<iAh::_'0 . .,' _:. ... : ;'w, . ri'},. '. . ,', .'." _',' .,'.', >_'-!;?ftfu.'fh--i':fi>'_:: ",'Y,
1 I 0 Residential I 0 Government I 0 Commercial I
1,,';f;,\:jOB'JSITE,INI".ClRMATIONfJ;Af\lDJll!'ClCAtION~':'.s~;:1
I Job site address: :1."!:c."SOJ'jitY.;JPi'C I
I City: 8.?fL \) , I Stat~: oR. I ZIP: I
I Reference: I Taxlot.: I
440-258~-J (9/08/COM) ~
I Residential, per unit, senrice inclJ'dcd:
11,000 sq, ft, or less (4)
I Each.additional500 sq. ft. or portion"
thereof
I ,Limited-energy (2)
Each manufactured. home'or -modular
dwelling service Of, feeder (2)
$134,00
$
$ 25,00
$
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$ 32.00
$
$ 63.00
$
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$ I
$ ( ',;\1
, P----I
$
$58.00
$
(A) Enter subtotal of above- fees
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,<Minimu~ 'Permit FeeSS8.00) -.. :
I (IJlEnt,r 12%-suftharge(.12 x [A]): '
I (e) Technology Fee (5'%"0f[A]) , .. ' ,I '
I TOTAL fees and surcharges (A,(hrough C):
· '-:'''', $ Lo~
'$ "1, c..'I_
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