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HomeMy WebLinkAboutPermit Electrical 2011-8-22 Electrical Permit Application ~~,"h'_1. "w. If'~ '%"Z.;'" ,f"" ." ".".": !:~""'_~~~ "'~ ,;~I'FY:~+~~rlpJSJ.q~~~p, ',@~~~9'~,. ';; 225 Fifth Streett Springfield, OR 97477. PH(541)726~3753. FAX(541)726-3689 SPRINGPIELD ~ U:;;;. ~~.. ,.~"'!i Ci"i,'l! ~.~ ~':._..~.~ "DEPARTMENT"iJSE.ONLY' ''0''"' "".....x:".y:..::.":...:::......:.:..;::....... ..j.....,.. 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- .~ o~\Ctf2.\C\q . . 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 '..' 5t:Vl-v l c..f: .fLr. tAEc-1- . . ,'-' ',PROPERTY:OWNER'i';' Y'AW'\I~ ~OC-r-t+ 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) , ...';" 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 $ ') ~. (0" ~t~ ~ O..;c::-I\-