HomeMy WebLinkAboutPermit Electrical 2011-8-22
Electrical Permit Application
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225 Fifth Streett Springfield, OR 97477. PH(541)726~3753. FAX(541)726-3689
SPRINGPIELD ~
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"DEPARTMENT"iJSE.ONLY'
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Date:
~O( ?O Z-
? -22~ / /
Permit no.:
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.
Each lldditioDlIJ inspection: (I) $58.00 $
,'x;U. "'t,::;, ~ ,APpLIcANT .. USE' ,,' "
\ ~~~~~ (A) Enter subtotal of above fees $ 1"7
W (Minimum Permit Fec $58.00) t7 ..;>
IfQ (B) Enter 12% surcharge (,12 x [A)) $ 7 ~ "
~ (C) Technology Fee (5% orrA)) $ ,./'f"i
"\ ...~ TOTAL fees and surcharges (A t~h'Cr ' - $ "7 ~ ,?i-
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. . LOCAL GOVERNMENT APPROVAL .,
Zoning approval verified? 0 Yes 0 No
"CA TEGORY: OF .CONSTRUCTION .
,0'Residential I 0 Government I 0 Commercial
'. .' JOB..SITEINFORMATION AND LOCATION' ;-
Job site address: Sq I S S-{ 5T i> I lie €.
City: ScJ 0 A I State: 6 r ZIP: "I; '1~
Reference: V I fSoZ- 0 'i Z-( r Taxlo!.: 0/ So-a
I,.' ,. ,. "DESCRIPTION OF :WClRK '..'
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,'-' ',PROPERTY:OWNER'i';'
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Address .5 't I .5 s: I ~ 'r t:>k:..
s ~ F ~ I State: uL ZIP:"} '7'( 7.2
Phone: - - I Fax: - -
Name:
City:
E-mail:
This installation is being made on residential or farm property
owned by me or a member afmy immediate family. This
property is not intended for sale, exchange, lease, Of rent. OAR
479,540(1) and 479,560(1).
Signature:
C.ONTRACTOR INSTALLATION "".
Business name: ff\ V ~ \ ec.'1-:Y' t <. > A..) I ~,
Address: ~;;;t "" '(" RrilJP <I I l ,
City:("~, Af '~~ 'I StateC Tlt ZIP: 9'7U ~d
Phone:,ctl- -9t:l I l( 5t{ [Fax,::z!) -7b 6""" ~
E-mail: rl\dofJ~.>J-y.\.C.~...N\.Il\/.(.;). \l>f\r-,()-,
CCB licenslno,:7\7,"-Oh I BCD licensene '))-?>'5Ilc.
Signing supervisor's license no,: ?J f), n \. l)J ,
Print name of signing supervisor: C"d~l\.oJ~, ~M""
Signature of signing supervisor: - ~lf.:J ~ ~"
440.2584-J (O/OS/COM)
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FEE 'SCHEDULE '.
N,. ~ITI-ber 0,_ finspect,i:ons pcl"itenrO.' ~Qty. Cost-' I Total
_ ' :ea. ,cost
Residential, pcr unit, service includetl:
1,000 sq, ft, or less (4)
Each additional 500 sq. ft, or portion
thereof
Limited energy (2)
Each manufactured home or modular
dwelling service or feeder (2)
$134,00 $
$ 25,00 $
$ 32,00 $
$ 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) I $ 63,00 $b~
Temporary services or feeders: installation, alteration, relocation
200 amps or less (2)
201 [0400 amps (2)
40 I to 600 amps (2)
$ 63,00 $
$ 87,00 $
$126,00 $
Over 600 amps or 1,000 volts. see services or feeders section above
Branch circuits: new, aI/era/ion, extension per panel
a. Fee for branch circuits with purchase of a service or feeder fee:
Each branch circuit
I
$ 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 limitcd~cnergy panel,
alteration, or extension (2)
$ 63,00 $
$ 63,00 $
$ 63,00 $
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