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
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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.
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-. . :, ';,....:.. .'C.." ,....;.': . Cost "Total'
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Residential, per unit, service included:
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Zoning approval verified? 0 Ves 0 No
i~":;:~f;'i":,'i,::cMEGORY~:.c5I7XCc5NSTRUCTloN~:~' .,,;;.,. ; .
IDesidential I D Government .1 D Commercial
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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
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200 amps or less (2) $ 81.00 $
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'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 $
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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 <:..
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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
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(A) Enter subtotal of above fees
(Minimum Permit Fee $58,00)
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$
(B) Enter 12% surcharge (.12 x [AD $
(C) Technology Fee (5% of [AD $
TOTAL fees .and surcharges (A through C): $