HomeMy WebLinkAboutPermit Electrical 2003-5-21
225 FIFTH STREET · SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number f3.-tZ003......0 0/33 Date
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LEGAL "O)TZNl/ ~ I 630 2-f
JOB Dk;r;~ VleV\t1 oJJ
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
q 40 I Amps to 600 Amps
Expiration Date - / -0 L/ ~Q;.~" Over 600 Amps or I 000 Volts see "~:: above.
S. fS" EI ',. <~~ .....\.~ D
Ignature 0 upervlsmg ectncmn ~~v {:> '..... . '\ . '
~~~ ~# ~\;)~ New AIterat.i.o n or Ext~s11~..,e& p~tl~.'el~~>'.
~ . '0.-.\\\' 0'<.6:> e S J:S'
- - One CIrcUIt " \ \ ~e c.:, '2}.'\ ,..0?~ : I(r$ 43.00
JJ . ". '\:~~ S> ". , Ea...c h.. A.. d. ditipri~Y SiJ;q.dit qrj~Oi~ ~y\ -. ~\..~ ;2}':,;;I eI
~<;N \"'''\\A. s.e..rv.......is.e.,\'o.tF.e~a€~l\l;(ortrn ~'(\\p 1\~~~ ._,A~:~3.00
Owners Name _" .;Xl. \ ~ Uy \ ." '. \ ", '().o.v. '\. '. ",r{.O\}::" {) . ~9~ _",\\0
~ . ~~....7'..) IS:h V\ I "Y I^, f v;6 '>:E:J"'''~~W~ .
Address A..~ <. .~ IQ' ~.~~u., \ rc 'Ul , '..,~<;f"~~')~l .
~~_y ;\) ~'V --n17 3'7' y \0, ",;S'.y.;I-' ,0":\ \:' \\\\ ?'O
City , ,(~, . ~hone 1"1 -- ,-.\Q\p~ mp';tir f.rrjg7it.io.rn. :\~ e; 'n,(\C'\\ ~~'l.w $ 50.00
, _\."<' ...\>;- v , . \,,,,, . 'n\) \ CIO' ",\10':1 ~_~.
~'V ~00.'" 'O~ \\\'Sige!putIin@~I3ig~tw'g' V'6C\ $ 50.00
-~~~ ,.C\'.) \"'~() .,...:{ ,\, '.~
OWNER INSTAlL TION "t;imite(l'EnergYfResidential $ 25.00
~ ..., -i.o'6' re~\.'-
The installation is being made on property lawn which LimHed'Energyi'Commercial $ 45.00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
I'ermll~ are non-tran~ferable and expire If work I~
not ~tarted within 180 days of 1~~lIance or If work Is
Suspended for 180 days.
2.
Electrical Contractor ..c ~ s r:'lfCA'l~IC I JAf\C., ,
P. D, SD'i \L\~ J-
eily sr{1 rd~(' I j, Phone I Lj 1- 2 2 ~?'l.
Supervisor License Number L{.<g q L\ S
\ D-Ol-04-
Address
Expiration Date
Constr. Contr. Number
~3~Llq
Owners Signature:
Inspection Request: 726-3769
5/21!(')3
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3.
1:ry'l''f::r1! "'!-'f:"" >'.~; -";.i'....,.,. :'i<::(,./C1!!";7I";:.... :'~:.-<::,i~, V~~::;;;i,/i'!%,~A'''_",/:~,j'-''''~'''<!i~'
PLE1'E,1<"EE;SCH . '.
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A. ~~Ne.-rtlJ{cSitl
fi'_; ~":.;',: ,,:t'}.L~}' ,V\:~ ~>:'.~"i
Service Included
I 000 sq. ft. or le'ss
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B.
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c.
'$ 50.00
$ 69.00
$100.00
LJ3
3:q
4.
Lllo
3.22-
4, It; ()
S3. cg2-
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application 1-03,doc
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1:
City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00133
5/21/2003
5/21/2003
11/21/2003
SITE ADDRESS: 2782 CANTERBURY ST
ASSESSOR'S PARCEL NO.: 1703244103028
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Residential
PROJECT DESCRIPTION: Add 2 circuits
OWNER/APPLICANT:
CYDNEY WILSON
2782 CANTERBURY ST
SPRINGFIELD OR 97477
541-747-3704
ELECTRICAL CONTRACTOR:
C & SELECTRIC 541-741-2236
P.O. BOX 1482
SPRINGFIELD OR 97477
CCB # 3849 Expiration Date: 09/01/2004
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee 4.60 OS/21/2003 1200200000000001284
+ 7% State Surcharge 3.22 ~~1/2003 1200200000000001284
Add, Alter, Extend Circ 43.00 \\\t. Q~1/2003 1200200000000001284
Add, Alter, Extend Circ Ea Add 3.00 o'~t. \t "1\\\ \CO 0:;/21/2003 1200200000000001284
\ ,~\..'- (',;..'l.'~\~~t\.J\~\) ,Q~
To Request an inspection cal1~\bo~r~'(Wdlt~a\'V2 -J~~ ~ll inspections requested before 7:00 a.m. will be made the same
working day, inspections r\Q\\~\~~~r\'7~Q)~\~. ~i~'D~ ade the following working day.
,\\\~\ {\~\1t: __\"\ \\~ \~(\,
~\) \ ':I\\:..~\J\"'~ \>"''' J
Reouired Insoections: CJ\)~\'l\ CO\) \)~
1 Rough Electric: Prior to~~il-e)
2 Final Electric: When all electrical work is complete,
By Signature, I state and agree, that I have carefully examined the completed applicJ!,iqfil'd~~ do hereby certify that all
information hereon is true and correct, and I further certify that any a?d,a!! wor.'R\B~~~r.D1~d~h~ll be done in accordance with
the Ordinances of the City of Springfield and the laws of the ~t~te(Qf;'Qr'eltonitear.rifiing, t9::tIiP~ork described herein. I further
, , "N v ~ ~~ \.. _ ~\ v (\() ,
certify that only contractors and employees who are..in_~~fQipliaitcewJtli eR~~Q..iH055 wjlbl~'e:used on this project. I further agree
to ensure that all required inspections are request'e(l 'ahh&\ptfop~~timer'th~f each'lcicl'~ss is,i;e~d~l>le from the street, and that
th d t f I 'f I' bl '11 . \\t"\\flf'h' . r-r.>~II\::it\: - ~li'~O~':ll" ~ bne '.VO e
e approve se 0 pans, I app Ica e, WI rema\l)1 0'.1 ~\~\t.e,atJa G~e~s uunng,sonstructip,Ib'\\
NO\\'\C~ 952'00~' o'O\a\'\\ C~~~~ \ne \e~~\ca\\on
..... oP\ . _ d {'(\a~ :\,ef IN H'\'~" N
Owner or Contractors Signature 'o090. ~v- \ne Cen O{eI~atg U~'i.i'3AA-l'
ca\\\n9 \Of \ne . ~ -'oGO.'3'3
,\~'oe{ :\,e\ \S
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Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfiehl
Development Services Department
Public Works Department
Official Receipt
Receipt #: 1200200000000001284
Date: OS/21/2003
Job/Journal Number
ELE2003-00 133
ELE2003-00 133
ELE2003-00 133
ELE2003-00 133
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Amount Paid
Item Total:
43.00
3.00
4.60
3.22
$53.82
Payments:
Type of Payment
Check
Paid By
C & SELECTRIC
Received By
djb
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
53.82
$53.82
5/21/2003
2:23:30PM
Page I of I
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