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HomeMy WebLinkAboutPermit Electrical 2010-10-12 225 Fifth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726-3689 ,",,'- --...._- .."- . ,"'""'"..... "DEPARTMENT USE ONLY ,., r___'.:"';"'A "'.:__.i ,:...:._"-'~.Yj',, "'- Date: /eJ ___/L-_/O This permit is issued uuder OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issu.ance or if work is suspended for 180 days. ";:;JIii~j~4:i~"'OC,6.Ii!;;GOVERNMENT~AP.F!ROVAL ;~\~'1'l~t{'\;"., Zoning approval verified? DYes D No '\,\~:\Qi~,:I~)~i';CATEGORY0;OfJCONSTRUCTION".;~ ;,::<,5;;' , o Residential I 0 Government I 0 Commercial :~~,;i,;;;JOB,;SITE;INFORM,6.TION2ANO!\L:OCATION: ... '"7' Job sit~ address:M 7 J(/f .:3/ Ci ' / }/tl../" I StatetP ZIP: Cf 7/11] subdivrsjl: 10 ~\ I Lot non'~") f~~:,,:,:~::;,~"~.:~;~t~(,:~~~~:DESCRIRTION;.\O~,~lWORK'~';::~:;<.r~::,r;l~r(~\-~. ,~":~~:~ /v4rj d~ ~r~x~\~]::i".:,:~~;f:,~~~~~_~~~~~RORERry;'IO_WNER-?;';::'~;:iJ~;;;r".~7~~"~~'.~:'\ti":~':~::0~r; Name(/ \VI I --t;;yf- h:;;; .1 jh/Y711/1 DIu Addr:ss:/,,6 p~': /,~-- I CiOl:<../?// ~ l State!}0 Z,r'J7'?117 Phone: 0- . I Fax: E-mail: This installation is being made on residential or farm property owned by me or a member of my immediate family, This property is not intended for sale, exchange, leas,e, or rent. OAR 479.540( 1) and 479.560(1). Signature: \":"Ni:\';i~;f"";C'ONT. 'RA'C. T OR;'INST. A',...ATION'....~" .W,', .~',\.,,__.._'.' --.k",,;c,' J"".". .... ." ' '., L.;;LJ':'. -- .. .'. .)}, '--';;-." "'-"" ~ ;-".'~- '., ;'" Business name: {\ 0 J I \ -f 1 h A; ): J ; .11th' ;. J Address: (JD /J, .... / ...2J 5'03 City:f' I /"Jd /WfJ -I State:/'d'. ZIp(J7t/O:;L Phone:t:,l/f -t.'Rt,_........ ,~I Fax;~'i I Mt, ~-" ,- E-mail: .+. .., 'IJ "'n....... ,,,JOl'r.;...,,;. ~~ CCB license no.: 5m X' ~ I BCD license noblJ-f </Sc.. Signing supervisor's license no.: ~ ""')~;;) ..s Print name of signing supervisoAl> Ii I ."', 1J ,i e.L/ Signature of signing supervisor: d ~~ {/'/ ,,,,< , f ~ utaq v/1@ fYAP1d , L/ 0 . cpvcL if -{)uJr'~ &/;;o/u ",,,.,,'~m", \~ 1,,"";''-' ,;;;:','..fEE !SCHEDULE . r, - "%l.V ._i'. . tJ',~ -'-:... .." ,<'0'1'- ""'" ; -, ~ N~l!1be!,:pfl~sPr.ctJ01!S per,i~em (')~" Qty. Residential, per unit, sen'ice included:, """:,," '.' Cost ea. . Total cost $J~ ~ tis < ttl $ $ t,OOO sq. ft. ortess(4) Each additional 500 sq, ft. or portion thcreof / $134.00 / $ 25.00 $ 32.00 Limited en'crgy (2) Each manufactured home or modular dwelling service or feeder (2) $ 63.00 Services or feeders: instaltation, cilteration, relocation 200 amps or less (2) $ 81.00 $ 201 to 400 amps (2) $ 95.00 $ 401 to 600 amps (2) $158.00 $ 601 to 1,000 amps (2) $205.00 $ Over 1,000 amps or volts (2) $469.00 $ ~econnect only (2) $ 63.00 $ Temporary sen'ices or feeders: i,!sta!!ation, alteration, relocation 200 amps or less (2) 20t (0400 amps (2) 40 I (0 600 amps (2) $ 63.00 $ $ 87.00 $ $126.00 $ Over 600 amps or 1,000 volts, see services or feeders section ahove Branch circuits: new, alteration, extension per panel a. Fee for branch circuits with purchase of a service or feeder fee: Each branch circuit $ 6.00 $ b, Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each additional branch circuit $ 55.00 $ $ 6,00 $ Miscellaneous fees: service or feeder not included Each pump or irrigation circle (2). Each sign or outline lighting (2) Signal circuit or a Iimited.cnergy panel, alteration, or extension (2) $ 63.00 $ . $ 63.00 $ $ 63.00 $ Each additional inspection: (1) $56.00 $ ~~~tff1i~~~\1~~~~JfAeR1IICA.NT~O::HE~~I;~~=t~~f:;,;:f~~i~\~;"! (A) Entcr subtotal of above fees (Minimum Permit Fcc $58.00) (B) Enter 12% surcharge (,12 x [A]) (C) Technology Fec (5% of[AJ) TOTAL fees and surcharges (A through C): $ /5C; . zrY $ [C-1. Dc 3 $ l~, $/.ft::;.05