HomeMy WebLinkAboutPermit Electrical 2010-1-21
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Electrical Permit Application
SPRINCFlELD DEPARTMENT USE ONl vi
Iiii: ~ Penn it no.:Oo.k1 ze-W~b~
I Date: L/ ~1-~ I
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!#TIV OF SPRTNGFIELD, OREGON ''I<'
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225 Flftb Str~et+SpriDgfield, OR 97477+PH(541)726-3753+FAX(S41)726-3689
This permit is issued uuder 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.
lOCAL GOVERNMENT\6,F!PROVAl I FEE SCHEDULE
Zoning approval verified? {2jYes DNo I I Number of inspections per iteni () IQty.l. Cost
CATEGORV OF CONSTRUCTION I ea.
I I I I Resid~ntia.I_, per u.nit, service included:
r};( Residential 0 Government 0 Commercial
I' "' JOB SITE INFORMATION AND 'LOCATION I I 1,000 sq. ft. or 1ess (4) I
I. ;-rr?l ~I/' ~/. /f..Jd 1 I Each additional 500 sq. ft. or portion I
Job SIte address: ""',>'::>)1 f/1/"./v-<. ~ IC fer thereof
I City: ~P;:(rI - I State:QIC I ZIr0fl~ 1 Limited energy (2) 1
1 Refere'rice: \"1Q1J~.,.,?-,\12.. T Taxlot.:(X)Wlo I Eachmanufacturedhomeormodular I
I DESCRIPTION OF WORK' . I dwellmg semce or feeder (2)
I ~ ~.. ..-.. H..b::::J ~ /j/X 18 I I Services or feeders: installation, alteration, relocation
I ~_...rr-{;-hcl /J . } I I 200 amps or less (2) $ 81.00 $
I / PROPERTY. OWNER I I 201 to 400 amps (2) $ 95.00 $
I Name: ~ /ffvt/6. 1 140t to 600 amps (2) $158.00 $
I Address:S~'52 Tlf<<R.srOtJ RDNP 1 1601 to 1,000 amps (2) $205.00 $
City: ?m",eJ~",~~ate: OIL I zIP:Cff1' 1 I Over t,OOO amps or volts (2) $469.00 $
I Phone:9ff.~Z{- tJUl'~ 1 Fax: _ _ I I Reconnect only (2) $ 63.00 $
E-~il: d C(_/:;;;- y- / iJ 0~f' d~ T: ~n- I Temporary services or feeders: installation, alteration, relocation
This installatio'n is being made on residential or fann property I 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family. This 1 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or rent. OAR I
479.540(1) and 479.560(1). 40t to 600 amps (2) $126.00 $
Signature: J Over 600 amps or 1,000 volts, see services or feeders section above
I CONTRACTOR INSTALLATION 1 Branch circuits: new, alteration, extension per panel
Business name: /YI~ ~f2.-.... I a. Fee for branch circuits with purchase ofa service or feeder fee:
Address: I Each branch circuit 1 $ 6.00 I $
City: \ State: I ZlP: I I b. Fee for branch circuits without purchase ofa service, or feeder fee:
1 Phone15ll1/~/ ~ La:1- I Fax: 1 1 First branch circuit (2) I $ 55.00 I $
IE-mail:" I I Each additional branch circuit $ 6.00 $
r CCB license no,: r BCD license no.: I 1 Miscellaneous fees: service orfteder not included
I Signing supervisor's license no,: /11LJ I I Each pump or irrigation circle (2) $ 63.00
1 Print name of signing supervisor: ,/ / (L 1 1 Each sign or outline lighting (2) $ 63.00
I Signature of signing supervisor: /.,~, /' ., Y . '//. _ iY? I I Signal circuit or a limited-energy panel, $ 63.00 $
:I/~?4'9:t ~./v /' alteratIon, or extenSIon (2)
*' - ::;-ze......@ 1-81 . / I Each additional inspection: (I) $58.001 $
I
$134.00
$ 25.00
$ 32.00
$ 63.00
$
$
1
APPLICANT USE
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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])
1 TOTAL fees and surcharges (A through C):
$
$
$
$
440-2584-J (9/08/COM)
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Total'l
.cost
1
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1
1
1
1
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1
1
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1
I
I
1
I
1
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1
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$
$
$
$