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 {-; ;;- ~:
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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
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