Loading...
HomeMy WebLinkAboutPermit Electrical 2010-3-23 Electrical Permit Application . . 225 Fifth Street. Springfield, OR 97477 tPH(541)726-375H FAX(54t)726-3689 I:iEPARTNiENTUSE ONLY ",/'::.", '.. co LA-'\ "ZOo ? -0 "7 c:r Pennit no.: Date: ::s 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. rG~"~'~m(?c~*~~1~~f.~~W{~I;,EE~,$'CHE.D.U~E'~~~~~~%:;~1f~~q~~~,~~~~ -. . :, ';,....:.. .'C.." ,....;.': . Cost "Total' ~.N~~_~.~~.o..~;~~~.p~~t~?~t~',~~r;-i~t~~,,~\.{.> 9.t~. i' "fJ~."i .'0 ,." Cf)st Residential, per unit, service included: :1\' ....' ""'EOCALi:'GOVERNMENl':,t\P'PR.OVAIB'W("1:W;~"':.;\:1, Zoning approval verified? 0 Ves 0 No i~":;:~f;'i":,'i,::cMEGORY~:.c5I7XCc5NSTRUCTloN~:~' .,,;;.,. ; . IDesidential I D Government .1 D Commercial l\ji[~;;j'd.oB'ii$I:rE:~IN F,QRIIIIATIQ liIKAN [jmIIQc'M!I.oN~~~ii~t\7i(!'; Job site address:. 3847,. ' E Sr City: $p",'MF:"o I State: OIL I ZIP: 91"11-8 Reference: /702- "3 II s. I Taxlol.: 11300 " .'. '. :. :' 'DESCRIPTION:. OF WORKi:)?,,>~ ""i)":';;"': ,-:, r' Sr- Services or feeders: installation, alteration, relocation r;;u:.crl'i,-+}<-.. fA<.Jlcc 200 amps or less (2) $ 81.00 $ p.:r.;~" WO(t/L c. 'PROPERTY OWNER .... ... 201 to 400 amps (2) $ 95,00 $ Name: 1c..LJN\. rM,A-L rLAL 401 to 600 amps (2) $158.00 $ Address: 97f Z Sol.) ,A--LA13t4wtA- s.T 601 to 1,000 amps (2) $205.00 $ City: TU.At.A1LN I State: c,R..... I ZIP: 9' 7062 Over 1,000 amps or volts (2) $469.00 $ Phone: _ _ T Fax: _ _ RecoM~nly (2) $ 63.00 $ E-mail: -^.u\ias~~~icesorfeeders:lnstallatlOn.aiteratlOn.reiocatlOn ThIs installatIOn is being made on residential or farm p,r8P~ '~~' '~~ [~~~~2) $ 63.00 $ owned b~ me or a member of my Immediate ~a.N.ilp(j'It~~O( ~",a\'~. <l20~~~~'ffl' $ 87.00 $ property IS not tntended for sale, exchang%.V.e)\~~ ~!(te~Z;O\': II ~ .", 479.540(l)and479560(1). _,.(1; '36o?asa(~a.9~'2;_\\\~ 'O\c o amps (2) $126.00 $ ,as ~'(\o 0""- ~c"" la .' Signature' (\J.'''''f\\e~:....~\).~~ ^~0S ~~(~e Over 600 amps or 1,000 volts, see services or feeders sectIon above . ..:C.oNTRACTOR INSTAL~~ W:,,(\\'()0~~'l.:ty Branch circuits: new, alteratIOn, extension per panel Business name: S:UIIE Hfi tide.. ~~~~9'(\o.\~ \_'00"- a. Fee for branch circuits with purchase of a service or feeder fee: Address: f.e), /?of '+-11' f ca~"" Each branch circuit $ 6,00 $ City: Wlj.... T State: I ZIP: b. Fee for branch circuits without purchase of a service or feeder fee: Phone:~-S4'- 19221-24'; I Fax: -S'O- ''141-108S First branch circuit (2) $ 55.00 $ E-mail: Each additional branch circuit $ 6.00 $ CCB license no.: 1'-1'1'19. 1 BCD license no.: 2a - '-I1z <:.. .JS-r 1- ,> STEiJE !MUG/<:.. iL AL If f( Signing supervisor's license no.: Print name of signing supervisor: Signature of signing supervisor: NOTICE: THIS PERMIT SHALL EXPIRE IF !HI; WORK AUTHORIZED UNDER THIS PERMIT IS NOT COMMENCED ORIS ABANDONED FOR ANY 180 DAY PERIOD. 440-2584-1 (9/08/COM) 1,000 sq. ft. or less (4) $134.00 $ Each additional 500 sq. ft. or portion $ 25.00 $ thereof Limited energy (2) $ 32.00 $ Each manufactured home or modular $ 63.00 $ dwelling service or feeder (2) Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2) Each sign or outline lighting (2) Signal circuit or a limited-energy panel, alteration, or extension (2) $ 63.00 $ 63.00 $ $ $ $ $ 63.00 Each additional inspection: (1) $58.00 ~~~ (A) Enter subtotal of above fees (Minimum Permit Fee $58,00) ,;,', $ (B) Enter 12% surcharge (.12 x [AD $ (C) Technology Fee (5% of [AD $ TOTAL fees .and surcharges (A through C): $