HomeMy WebLinkAboutPermit Electrical 2011-3-4
, _ This permit is issued under OAR 9111-309-0000. Permits are nonlransferable. P.rmits .xpire jfwork is not started within 180
days of i~suance or if WQrk is suspend~.d_ for .180 ~aY5.
-~.-
B6/287?g~l~~~~, 7263675
'~_ Electrical"Permit=Application
-CITY OF SPRINGFIELD, OREGON
_Z25~iflh Str..ttSprin~n.ld"O!:t 97.477 + P8(541)726.31.53+ FAX(541)726-36B9
- --
- ------ -"--
~---- --
LOCAL GOVERNMENT APPROVAL "
Zoning approval verified? 0 Yes 0 No
CATEGORY 'OF ,CONSTRUCTION
[fResidential - 1 0 Government I 0 Commercial
- -' h'''''J,OS:SITE'lNFORNlATIONAND,:1.0CATlor;r;,' " ~l
_ Job aite address: -5~S:- }!A' C. A I C ~~ II )l ~
City: SiR \) State:;f)L. 1 ZIP: 7/'i' ~
Reference: \~ 'l/') ~ ? 1 ' I Taxiot.:
~ SCRIPTION OF WORK'
I WIVZb L ""?
PROPERTY OWNER
'Nattie: t+rf"'tpiiflT'
Address: ? 4&'-( fc,{J1-C/ t-11- P L
City:R,b /) -' 7J State:/117 I ZIP: "i'17 ,n.
Phone: - - _ ". I Fax: - .
E-mail: -- ' -, - - " -
-This installation ,is oeingmade on residential or fann 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(]) and 479.560(1).
Signature;
,
- CONTRACTOR INSTALLATION
Business name: (...!,-ar1-"\.t/y' 1=1 - I r I' 6
Address:~ t1-:J.-O q h ,,,,-.J "'A
City: J 1 ~ II ' I State: od2. I ZIP: Q71.J 3-
Phone~~ JPLk? ,<(cg:::.;r-I Fax:'5JY> /.RbI;;) -7'1;JS;-
.E-mail: I<:rh~~, ',j",~ty ~ " lr.,'~
CCBliunseno.;/;),IJ5Q ~jcen'en/: ~"~ -c.
Signing supervisor's liee~-;:J,707S
Print name of signing sup~
Signature of signing supervisor: . ---z:/Y -... ' . Ie-
.5I~#Rjv{IZF t-J/T~:rS-c-;,!:>6'f
cP/2(J ~gv~
~
440-2584.) (9/08/COM)
~\V \\
<\~
-N~
CITY OF 5PRINGFIELD~~~--~
PAGE 01
DEPARTMENT USE ONLY
SPmllfQl'tIl!I.D ~',~.~
. .
,j.. ,.4ll" f
",",,~~!l<J;\'El!~
~$~ ~ 'Ij~::,~, '
~'~f:~i~d:~:~~.t"'" _",-
Permit nO,: $1 J - '6 ~ '7
.. .. ",.,"'FEE SCFlEDUlE,', ;':.. >:.
COSt
Number ofin.pection. per item ( ).' Qty. ..' .a.
Residential, pe.r u"it, service included:
','.
".,
Total
co.t
1.000 sq, ft. orless (4)
Each additional 500 sq. ft. or pOrtion
thereof
Limited en orgy (2)
Each manufactured home or modular"
dwelling se-rvice or feeder (2)
I $134,00 $ (3<-{
'3 $ 25.00 $ r;(
$ 32,00 $
$' 63.00 $
Services or freelen: installation, alteration., relocatioil
200 amps or Jess (2) $ 81.00
$
$
$
$
$
$
20 I to 400 amps (2)
401 to 600 amps (2)
601 to 1.000 amps (2)
Over 1,,000 amp' or volts (2)
Rl:connect only (2)
$ 95.00
$158.00
$205,00
$469.00
$ 63.00
Temporaryservict!l or feeders: in:tallation, a.f!~rariDn. relocation
200 amps or less (2) I $ ~3.00 $ t;:'5
201 to 400 .mp' (2) $ 87.00 $
40] to 600 ampS (2) $126.00 $
Over 6-00 amps Of 1,000 ,",olt!:.. see services: or feeden; section above:
Branc:h circuib: new, alteration. ~Xl(nsjon per pan!!
~ Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit I $ 6,00 $
b, Foe for branch oircuits without purchase of 8 se~ice or feeder fee:
first branch circuit (2)
Each additional branch circuit
$ 55,00 $
$ 6.00 $
Mi~cellaneous fees: s~",lc~ or feeder ~O( tncludf-d
$ 63.00 $
$ ~3,00 $
$ 63.00 $
$58.00 I $
Each pump or irrigation cirCle (2)
Each sign or outline lighting (2)
Signal circuit or a limited-energy panel.
alteration. or extension (2)
E3th additional inspection: (1)
, ',,' ",' ',/i""APpLfCANTllSE
(A) Enter subtotal of above rees
(Minimum Permit Fee $58.00)
(8) Enter 12% surcharg. (,12 x [AD
(C) Technology Fee (5% of [All
TOTAL fees aod ..r<harge. (A thro.gh C):
$ 2?2- \
$ )Z-"'~
$ I?V~
$ 31~5