HomeMy WebLinkAboutPermit Electrical 2010-1-6
225 Fifth Street. Springfield, OR 97477HH(541)726-3753HAX(541)726-3689
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~.~ Permit no. (Jl1-/2~ 0
, . I Date: //6/1& .
Electrical Permit Application
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Tbis 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'N~m;;erofi~ip''e~ij~;riipirjt~in'() :':~I-Q-'~y.~1 'FO~~\I'',1:o'tal!1
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I.;~, .~A1;:';,;;:{:i'cATEGORYi"OI;}'C()NsTRU(mON1:.4f.,.'~;t:" ':i':'
I Residential, per unit, service included: I '
!~~~;'~,:~~~lmEiHN~&R~~~7;~~~N[ji1~~C~~lj(;~r~~~fj 11,000 sq. ft. or less (4) $134.00 $/5 L/ I
I () f\ \. ..r' I Each additional 500 sq. ft. or portion $ 11'---1
Job site address: :3 2. '8 N C'I ~e Jol thereof ~ $ 25.00 )
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I City: S?FL.\') I State: 0'-- I ZIP: I Limited energy (2) $ 32.00 $ I
I,.~e;~~e~ce: J'2~;S~~~~W0F..W~J~~;~\~~~ 1 ;~~~I~~nS~~~~~r~~ Fe~d:r (~)odular $ 63.00 $ I
,v-f: 1.J 5 I /J <:. t- i4- vV\ . i?J.cJ L-LI iJ ~ I I Services or feeders: ins/alia/ian, ai/era/ion. reloca/ion
I I I 200 amps or less (2) $ 81.00. $.
I . 'PROPERTY ,OWNER, ., 'I 1201 to 400 amps (2) $ 95.00 $
I Name:-6-Jl-t'SiC ",. TR.'^'-.-S., I I 401 to 600 amps (2) $158.00 $
I Address: 52-:;-(" L- "hc:.-c7'.\QIV 7 I 601 to 1,000 amps (2) $205.00 $
I City: .f:lA.t;" C,vt: I State: d7!---1 ZIP:'?") Cf ()cJ lOver 1,000 amps or volts (2) $469,00 $
I Phone: I Fax: I Reconnec\ only (2) $ 63.00 $
I E-mail: I Temporary services or feeders: installation, alteration, relocation
This installation is being made on residential or farm property I 200 amps or less (2) I $ 63.00 $ idS
owned by me or a member of my immediate family. This I 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR
479.540( I) and 479.560(1). I 401 to 600 amps (2) $126.00 $
Signature: lOver 600 amps or 1,000 volts, see services or feeders section above
.. . .: '.::CONTRACTOR.INSTAllATION:. I Branch circuits: new. al/eration, extension per panel
I Business name: ['V CIIj.Do.M 62-e.c1 r " <-- I I a. Fee for branch circuits with purchase ofa service or feeder fee:
I Address: 1')'1 9 2 ~c~fd I PIIJ, c.g .1 I Each branch circuit I $ 6.00 I $
I City:,) llY\cti O\'\. Q.,11/ State: oR I ZIP: 971./'IK I b, Feefor branch circuits without purchase ofa service or feederfee:
I Phone: 5VI- ~I c.. '1 "i"li I Fax: I First branch circuit (2) $ 55.00 $
I E-mail: I I Each additional branch circuit $ 6.00 $
I CCB license no.: I Jb n/ I BCD license no.: :20" 4'1/(, I I Miscellaneous fees: service or feeder not included
I Signing supervisor's license no.: 160 II'S I I Each pump or irrigation circle (2) $ 63.00
I Print name of signing supervisor: W fM(^~ L, AfliiH\9..~ I I Each sign or outline lighting (2) $ 63.00
I Signature of signing supervisor: /J ?".. u? ~.--rrI I I Signal. cIrcuit or a h~'l1ted-energy p~el, $ 63.00 $
-N~1l.1 ol.. ~----LtL- alteration, or extensIOn (2)
( I Each additional in.spection: (I) I $58.00 $
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58,00)
.1 (B) Enter 12% surcharge (.12 x [A])
I (C) Technology Fee (5% of [A])
I TOTAL fees and surcharges (A through C):
$ 2'72-
$ 52 ~
$ /3, (.
$ ~ ri .2- y
440-2584-J (9/08/COM)