HomeMy WebLinkAboutPermit Electrical 2009-7-27 (2)
225 Fifth Street. Springfield, OR 97477 +PH(541 )726-3753 +FAX(54l )726-3689
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I Permit no.: ('; ~~ 00
.1 Dale:
Electrical Permit Application
This permit is issued under OAR 918-309-0000. Permits are nontransferable. Per~its expire if work is'not started within 180
days of issuance or if work is suspended for 180 days,
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ll!=~~~i'~;fi0~Q()N~~gJ!!~mIQ~~'$1~1 I Residential, per Dnit, service inclDded:
~id:n~:,) _T.Dc.;o~:l1lID:.n~ ..t!i!I.DCornrnercial.1 11,000 sq ft, or les5(4) . ,! I \ $134.00 $ '\/~ i
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I Job site address:. b S' '3 Iv. 3 3 ~ I I ~~~~:fdditional 500 sq, ft, or portion i ~ $ 25,00 $ 5D I
I City: 5 P I( LD I State: 0 R. I ZIP: q 7 Y 7 71 I Limited energy (2) I $ 32.00 $ 1
i~~;_~Q~SQRIl?"1;j~)}j{0~lWJ~~~~1:_ I ~~~~i~~S~~~~r~~ ~~~:r (~)oduiar : I $ .63.00 $ I
I A.VD 11/0 IV - (( E \NI f( ( I 1 Services or feeders: installation, alterdtian, relocation I
I I 1 200 amps or less (2) ! ' \' $ 81,00 $ '3. t
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ICity:1(..<<J~-.FY;J-- rState?{W!lzrP: .IIOverl,000ampsOrvollS(2) $469.00 $ 1
I I I 1 Reconnect oniy (2) ,i, $ 63.00 $ I
Phone: - Fax: - -
r E-mail: I Temporary services or feeders: instal{ation, alteration, relocation J
This installation is being made on residential or farm property 1 200 amps or less (2) $ 63.00 $lo'~ I
owned by me or a member of my immediate family. This I 201 to 400 amps (2)' $ 87,00 $ 1
property is not intended for sale, exchange, lease, or rent. OAR
479.540(1) and 479.560(1), I 401 to 600 amps (2)1 I $126.00 $ I
Signature: lOver 600 amps or 1,000 volts, see servi~es or feeders section above I
~~C:0t'lil1~Qif1l!iR~INSil1.\\'l!~lli,QN~.'~ji!ilI~il~if~ I Branch circuits: new, alteration, exten~ian per panel I
Business name: E AS 1"5/ DE' E"L(c. T R. 1(.. . I I a, Feefor branch circuits with purchaselof. service or feeder fee: I
I Address: 3 )3.2.5'3 tp,OSCAG-f 6^""f. liE hb h' II I $ I $ I
- ac ranc cirCUIt 6,00 ' ,
I City: 5 pc;,:: CD I State: of( I ZIP: CJ 7 Y 7~, lib, Feefor branch circuits without purchase ofa service or feeder fee: I
1 Phone: - 7 Y 1-/ V91 1 Fax:, ,~: _ -73 (, - V % 0 I 1 First branch circuit (2) I $ 55,00 I $ 1
I E-mail: R/CKrl3ASTSIOE. i(i) YI-H ()(, ,(,6/].1 I I, Each additional branch circuit $ 6,00 $ 1
1 CCB lice'nse no,: II 7770 I BCD license no,; J 0 - y OS'c I I Miscellaneous fees: service or feeder notincluded I
I Signing supe~k~,1i~"fl!fuQan,.~~ reOi'Jtres VDU to I 1 Each pump or imgati~n c,ircle (2) $ 63,00 $ 1 .
1 Print name <fti~~!!iklq)~Blli~d ~(!he:,lG~on/'ll~i),lI G- 1 Each Sign or outlme lighting (2) $ 63,00 $ I
1 Si alure ^~?tltlcatlDn l;emer, I 'W~.I!,l u.;,'" "I "B'".i.lu.tt. Signal circuit or a limited-energy panel, I
go '1l(!l}\j!l~~\'li'lt".'i'lfJ1~~OAR~01. '_ flerauon,orextension(2) $ 63,00 $
0090. You may obtam copies of the rUle~ by .~ Each additional inspection: (1) $58.00 $ --
ca/ling the center. (Note: the lelepho e ~ Il!b"~""#i""~~" ,_ _~"' _. _y;,' ___,~_. '""" -
number for the Oregon Utility Notificat~ ~,,~ill~l:l ..Je:.&liL!tGA~;rr{.0SEIl,.~iEA1l1
\' t\~ .,.(),. Center is 1-800-332-244< A ~ CO pc: (A) Entersubtotal of abovefees
\j>V V " (\ -'\ \.~ \ ~ (Minimum Permit Fee $58.00) $
\\.\?~~ ' ;\'d-' ~ (B) En. ter 12% surcharge (.12 x [A]) . $
'f-'" 1 (c)TechnologyFl~\Il~~~?). $. . ,
\F (\ \l~ - A~ I TOTALfeesan~~BEJ~~*g~
~~,/ 9fJ( i\ . AUTHORIZED UNDER THIS PERMIT IS NOT
440-2584-1 (9/08/COM) \' ,\)::'\ COMMENCED OR IS ABANDONED FOR
\ \NY 180 DAY PERIOD.