HomeMy WebLinkAboutPermit Electrical 2009-10-30
This permit is issued under OAR 918-309-0000, Permits are nontransferable, Permits expire if work is not started within 180
days'of issuance or if work is suspended for 180 days, .
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I Zoning approval verified? 0 Yes 0 No I ':r~~Iri;;e;\;;f';~i;i~;i@fc~~~h1iri~()~~;i;IQt,1 ~.F6H;'(i,I';;r6tal'l
l;iJI);~;i~L;ii(~GMEGOR~;;OI;~'G()N$iI'Rutil'IOf'.l~\J'i~'~~i~.'!':,', I I"~;;;~:~;:i'~'t;;::;~~~:~~i~:'i:';;~;:~i:,.t,;",ea.:, .:., "cost, ." I '
I 0 ReSidential I 0 Government I J8{'Commerclal I I ' ,
11lr'!!'~'B'tlfoEl1i;.SlmE~INF;.QRIViA''fIolillrJ.l.N01,1I!()CA'liIONW't:f:ti61~11 1.000.sq It, or less (4) $134,00 $ I
I' , .1 0'7 / A ...-MD ~~ 1 I Each ~dditional 500 sq, It, or portion $ 25,00 $ I
Job SIte address, .-?l -Or.-. - A- ' ~ I ~,+:/( thereof
I City;..5?!~~ State:O-!- 1 zIP1'-:r/f71-1 Limited energy (2) $ 32,00 $ I
i,;~:::'.:,~~e'>'DESCRIPTION0F;W~~~~;~~J(i"";i"'~''f-;'!i""~"'[ I ;~~71~~nS~~~~~r~~ ~e~~~; (;)"odular. $ 63,00 $ I
1~.J.l . ~~~G-'" ;- - ..". ,~,' .,o.l:"" "~.,,~." '\:"1 I serVices:or feeders: installation, alt~ration, relocation I
1 I I 200 ~mps or less (2) $ 81.00 $ I
I " ;PROP,ERTY:;OWNER;.I I 201 to 400 amps (2) $ 95,00 $ I
I Name: iN ""...,,,.-; c' ~ c. ,.f/ I 1 401 t~ 600 amps (2) $158,00 $ I
I Address; 'l{ S 5'J 5 I'-V""..); - .~ I I 601 to, 1,000 amps (2) $205,00 $ I
I City; p--L,? _ 1 State: ~ I ZIP; C[ 7'---t~1--- I Over 1,000 amps or volts (2) $469,00 $ I
I Phone: . 5,'--11' s-it 7/11) Fax: ,I I Reconnect only (2), $ 63,00 I $ , '
I E-mail': I 1 Temporary services or feeders: installation, alteration, relocation \
Th" II' 'b' d 'd' I c I 200 amps or less (2) $ 6300 $ I
IS msta at10n IS emg ma.. e on res! entIa or larm property ,
owned by me or a member of my immediate ,family, This 1 201 to 400 amps (2) $ 87,00 $ I
property is not intended for sale, exchang'\..lease, or rent. OAR I I
479,540(1) and 479,560(1), 1"-..... 401 to 600 amps (2) $126,00 $
Signature: "" ~ ~----.::::::. ' I Over:600 amps or 1,000 volts, see services or feeders section above f
. ~ :', ':~::CONTRAGTOFf' IN$TAl:CATIOW,:,' , , .1 I Branch circuits: new, alteration, extensian per panel V 1
I Business name: 1'1~,.J 1-.. A T I TV O~ I 1 a. Fee for branch circuits with purchase of a se"rvice or feeder fee:
i I Address: 'J, 4- ?, D; VJ I \ ~ 1 I Each branch circuit I $ 6,00 I $
1 City: E:uc..~ rc--- 1 State:O~ I ZIV11'-tctL lib, Fee for branch circuits without purchase ofa service or feeder fee:
Phone: ,~tj t.j _ (,3"" C, I Fax: 1 First branch circuit (2) $ 55,00 $
E-mail:. I Each additional branch circuit $ 6.00 $
I CCB 1ic~nse no.03~ 11' I BCD license no.: I I Miscellaneous fees: service: or feeder ,:/ot included
1 Signing supervisor's license no.: b -; J ST& 1 I Each pump or irrigation circle (2) $ 63,00 $
1 Print name of signing supervisor: t-J~L .4\C;ONr-J~ Each,slgn or outlme hghtmg (2) $ 63,00 $
I Sio-nature of signing su'perviso.J..\ Q t' r\ _ i I Sign~l.circuit or a li~ited~energy panel, $ 63.00 $ I
o It'- J ~ 1-+( -1Il")v\'-""'--v alterat.lOn,or extenSIOn (2)
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Ele,ctdcal Permit Application
225 Fifth StreettSpdngfield; OR 9747HPH(541)726,3753tFAX(541)726.3689
440,2584,J (9/08/COM) ,
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11L>oEPARTMENT;us'EONISY';t,.,.;;I'
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Ipe~it no. (' C{ - 1 ::;.::;;~ I
I Date: le - ZA'-8'r I
(A) Enter subtotal of above' fees
(Minimum Permit Fee $58.00)
,I (B) Enter 12% surcharge (,12 x [AD
I (C) Technolog'/I'ee (6% of [AD
I TOTAL fees and surcharges (A through C):
$
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