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HomeMy WebLinkAboutPermit Electrical 2002-10-4 ::..".~ FIFTH STREET SJ.'RINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 ELE~ JCAL PERMIT APPLICATION City Job Number 3. CO:tv1PLETE FEE SCHEDULE BELOW L LOCATIONOF IN~TALLATION i c / /J ,C.le; 1--<';>,'4/- A. New Residential-Single or Multi-Family per dwelling unit. ., "o\\b~ID\~f.:e Included: ! . ","<>d has 1.18 \ ~ , , '- -" "s SUOmlll" '.. \nnd US6 " lu\\ow\nQ \JIUjV-' "'sQulre SpSC\llG ,c. :\v . "Hi r',QeG nOe I ' JOA pESC~::IO~ ..' '-~;~;~c\(2'\\. t ' ,. /!,~.~1.2~)QQQsq,~: or less /-; ; ~', l lIen" J(.~; {l.J"./" IJ}i~'~ir,~,]-"'r-.~t ,_ ,.E(~~llaggmo,nal 500 . , .,JD.JOif It)~'''sq, ft or portIOn PermIts are llon-transferablt;;J3ttd ,expIre cfS~- .th.ereof' if work is not started within J8.Q~'Ws Each Manufd Home or / ,l>~. . of issuance or if work is suspended for Modular Dwelling 180 days, Service or Feeder LEGAL DESCRIPTION [(1"'-:;. F.~1;i.., U.1 ,. 2, CONTRACTOR INST ALLA TION ONLY Electrical' Contractor iT' J ,~ ...~~ I~,-l ,'1;-'" '*~:,.( -- ~ ~..... . B. Services or Feeders " Installation, Alterations or '1 ~,. i' (1;-' Relocation: Address / !~ / 200 amps or Iess;< 20 I amps to 4GD ~ntps' 401 amps to 60.Qatnps. 601 amps to1000a111,p$ , Over lOOO amps/volts '/f Reconnect Only Z (/,.:-" ., - t" / : ~ " City 1::-( Phone {-; ;;- ~: '} l/ Supervisor License Number ..:5 I.l q 75: Expiration Date 10/1/ {) '-I I Temporary Scrvices or Feeders Constr Contr. Number 10 If- f? 7'. Installation, Alteration or Rclocation Expiration Datel:J;/3 (.) ! 0 (:'01~f;t1,cA i. )00 amps or less /.f1!ly,. .,fyr 'l'." ' 2{J)il.mps to 400 amps Signature of Supervising Electrician I !J(; ".' I 11/ ,a~.~;~' 4&1 /9 ~9? amps ./'P;c-,:, /' ::9v~t ,sOP, (~m}1$/(J;)QiOO volts see "li';O/,. "B'1!"<}~I\:~"",~' ' , '/ i...//~:" D. Branch Circuits "".i New Alteration or Extension Per Panel Address I Owners N amc / C (, One Circuit City Phone l Each Additional Circuit or with Service or Feeder Permit i $ 3.00 .I (. OWNER INSTALLATION The installation is being made on property I o\vn which is not intended for sale, lease or rent. E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm Owners Signature: Items Cost S UI,11 $106,00 $ 19,00 $ 50,00 $ 63.00 $ 75.00 $125.00 $163.00 $375,00 $ 50.00 $50,00 $69.00 $100.00 $43.00 $50.00 $50,00 $25,00 $-1.5.00 Minimum Electric Permit Inspection Fee is S.t5.00 + Surcharges 4. SUBTOTAL OF ABOVE 7% State Surcharge 8% Administrative Fce TOTAL :.. a:.J-. i~ ' '~ ,. Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: ASSESSOR'S PARCEL NO.: City of Springfield Electrical Permit Attachment PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2002-00104 10/4/2002 10/4/2002 4/4/2003 1704 CARTER LN 1703253215500 Springfield TYPE OF WORK: TYPE OF USE: Addition Residential PROJECT DESCRIPTION: Electrical connections for mechanical permit OWNER/APPLICANT: ELECTRICAL CONTRACTOR: LEE & VIRG PREPGRASS 1704 CARTER LANE SPRINGFIELD OR 97477 pescriDtion Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 8% Administrative Fee + 7% State Surcharge 541-746-7082 KS ELECTRIC 541-686-6236 PO BOX 24933 EUGENE OR 97440 CCB # 70889 Expiration Date: 12/30/2004 Amount Paid Date Paid ReceiDt Number Cashier 43.00 10/04/2002 1200200000000000017 dIm 3.00 10/04/2002 1200200000000000017 dIm 3.68 10/04/2002 1200200000000000017 dIm 3.22 10/04/2002 1200200000000000017 dIm To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following working day. Reouired Insnections: 1 Rough Electric: Prior to Cover 2 Final Electric: When all electrical work is complete. By Signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, and that the approved set of plans, if applicable, will remain on the site at all times during construction. - Owner or Contractors Signature Date Page 1 of 1