HomeMy WebLinkAboutPermit Electrical 2011-1-28
Electrical Permit Application
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225 Fifth Street. Springfield, OR 97477.PH(541)726-3753tFAX(54t)726-3689
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, bE'P~~TMENtUSE ONLY
Sv'/Z.'Gcf(- 00 3 L
Permit no.:
Date 28"-//
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.
AITENTION
rules adople
Center. Tho
0010 through
copies of lhe Y g the cenler (Note the
~~e,;::~~e1~~~~;;~~~~~fregon Utility Notlfi~ation
"', " ,"iI10C~L;;GO"ERNMENT~F1f!ROVAIL';;:"'\i~},;g";\~1
Zoning approval verified? 0 Yes 0 No
.:/ii(cATEGORY,iOF:CONSTRUC:T10N\\> ' ,.
Residential D Government D Commercial
~i'fj;1':J,OB~SIT:E~INr:,ORNlAffiIONr~Nb&!L;OC'A'[IONw.>:1ii&f~rl
Job site address: L.( '8' S~ f-
City: S F State: 0\12- ZIP: q7 f
Reference: ,02'3 ZLJ Taxlot: 01700
., ' : DESCRIPTION: OF WClRk'ii.,;,:C'>:,F,y';,\",,",
vJll<-\::. SF
:PROPERTY OWNER
Name: \ 4-
Address: 10 OAt::-f'A-r-c.l+
City: C"lA ~~r:= State:0/L
Phone:5ttt- -7 . 'l Z S ! Fax:
.&matl~Nr~: ~o I:I.:l -;-e 7.4
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, lease, or rent OAR
479.540(1) and 479.560(1).
'Signature:
: CONTRACtOR INSTALLATION
Business name: --J5 G"4 rY? E"LFC7tZ...IC'
Address: 70 I)
City: Lrt- .. '-
Phone:,<;j-1.S- 19' z-
E-mail:
Signing supervisor's license no.:
Print name of signing supervisor:
Signature of signing supervisor:
55"635
ScA'"
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
440-2584-) (9108/COM)
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?N ~~ ~er'-~f!jnip~~~i?:'?,~',~~r,~~~l~.~(Y-~ ,'~:;~': 'q!Y-. . Cost " Total
i",~~3):'t ' ;':cost ':,_
Residential, per unit, service included:
1,000 sq. ft, or less (4) ( $134.00 $ }?,"I
Each additional 500 sq. ft. or portion I $ 25.00 $ 1-:;-
thereof
Limited energy (2) $ 32.00 $
Each manufactured home or modular $ $
dwelling service or feeder (2) 63.00
Services or feeders: installation, alteration, 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 $
Reconnect only (2) $ 63.00 $
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2) $ 63.00 $
201 to 400 amps (2) $ 87.00 $
401 to 600 amps (2) $126.00 $
Over 600 amps or 1,000 volts, see services or feeder~ section above
Branch circuits: new, alteration, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee;
Each branch clrcuit I $ 6.00 $
b. Fee for branch circuits without purchase of a service or feeder fee;
First branch circuit (2) $ 55.00 $
Each additional branch circuit $ 6.00 $
Miscellaoneous fees: service or feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) $ 63.00 $
Signal circuit or a limited-energy panel, $ 63.00 $
alteration, or extension (2)
Each additional inspection: (I) $58.00 $
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(A) Enter subtotal of above fees $/S~
(Minimum Permit Fee $58.00)
OO~!jofa1;r~w.r!lli~B" l~ fr.W\n1l, $ IT05
?~~&l~11p!j!j~%1llf[rA.1~on $ i '!~
Q ^ ~
~1!-(m.e9g~u' ',.. . ~~!&ough C): $jQ/O:
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