HomeMy WebLinkAboutPermit Electrical 2010-10-12
225 Fifth Street. Springfield, OR 97477. PH(541 )726-3753. FAX(541 )726-3689
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"DEPARTMENT USE ONLY
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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(~\-~. ,~":~~:~
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~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,',
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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 ~~
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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