HomeMy WebLinkAboutPermit Electrical 2010-10-7
225 Fifth Street. Springfield, OR 9747HPH(541)726-375HFAX(541)726-3689
" DE'PARTMENTUSE ONLY
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Permit no.:
Date: /0- 7-/0
This permit is issued uuder OAR 918-309-0000. Permits are uontransferable. Permits expire if work is not started witbin 180
days of issuance or if work is suspended for 180 days.
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Zoning approval verified? D Yes DNa ' . .. . ..........,....".':.. ,Cost Total
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-.. ,'.. ,-- .. . ResidentiaJ, per unit, service included:
-e(Residential I 0 Government T 0 Commercial
~~4j~~lJ.OBiSITE'IINI;QR.MATIQl\lr{Al\ljj&jI::QcAT:IOI\I~!7,{(J~ij 1,000 sq. ft. or less (4) $134.00 $
Job site address: I !J08 J) sr Each additional 500 sq. ft. or portion $ 25.00 $
thereof
City: ~;>,e"b I State: 0i\.- I ZIP: 9 7l{77 Limited energy (2) $ 32.00 $
Reference: J70-:!~ b(.'! I Taxlo!.: /0 ~c:.(:) Each manufactured home or modular $ 63.00 $
, .'DESCRIPTION OF WORK"j\,; ;,S2o dwelling service or feeder (2)
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~c...kv ~~ 1./ tl-l......c" Services or feeders: installation, alteration, relocation
I 200 amps or less (2) $ 81.00 $
'PROp,ERTYQWNER 201 to 400 amps (2) $ 95.00 $
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Name: PA-LT'MVA 'E{rrf(FS/l-r ,t' e-rA 't\ 401 to 600 amps (2) $158.00 $
Address: Ira f .!) s+ 601 to 1,000 amps (2) $205.00 $
City: ,>i:'~ State: tL I ZIP: 97477 Over 1,000 amps or volts (2) $469.00 $
Phone:~\ 72-&. ~Si'4 I Fax: - - Reconnect only (2) $ 63.00 $
E-mail: Temporary services or feeders: ins/aUa/ion, alteration, relocation
This installation is being made on residential or farm property 200 amps or less (2) $ 63.00 $
owned by me or a member of my immediate family. This 201 to 400 amps (2) $ 87.00 $
property is not intended for sale, exchange, lease, or ren!. OAR
479.540(1) and 479.560(1). 401 to 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 volts, see services or feeders section above
'.;iCONTRACTOR INSTALLATION Branch circuits: new, alteration, extension per panel
Business name: A-I ~LeCI(2l(' / a. Fee for branch circuits with purchase of a service or feeder fee:
Address:p '0, '?::/Q'f,. t.f l:6 f',9 Ii! Each branch circuit I $ 6.00 $
City: b-U q --eW-t" I State: Oe I ZIP: 'i7t.fO) b. Fee for branch circuits without purchase of a service or feeder fee:
Phone: s4/ - hn?,-Zr?71 Fax - - First branch circuit (2) T $ )8'60 $l{tJ
E-mail: C. ~&s Pi)f) tt) . GO MCllJS7:iVSr Each additional branch circuit 17 iy.dO $ 76
CCB license no.: 141'1'37 I BCD license no.: ZO-i/71C- Miscellaneous fees: service or feeder not included
Signing supervisor's license no.: 'fB80 Each pump or irrigation circle (2) $ 63.00 $
Print name of signing supervisor: gey~ L. met..6Y Each sign or outline lighting (2) $ 63.00 $
Signature of signing supervisor: .-fL, t,/j fA I Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
v~ Each additional inspection: (1) $58.00 $
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OV,.J~ (IIrt~ (A) Enter subtotal of above fees
roa. (Minimum Permit Fee $58.00) $
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(0- \11. (B) Enter 12% surcharge (.12 x [AD $
-;>~ (C) Technology Fee (5% of [AD $ ...
TOTAL rees and surcharges (A through C): $ ~I ') I
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440-2584-) (9/08/COM) ~\\,. b/voB
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