HomeMy WebLinkAboutPermit Electrical 2003-3-6
,
--
,ct as submitted has the tollowing
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX:zi"1~7~1l~ not require specific land use
epproval .A
ELECTRICAL PERMIT APPLICATION Zoning L:Or'-
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I.'LOCATION,O.FINS1'ALLA110N ;,f-",~,:,,"::. 3.: CO.,. Mflif:!Ei 'fEJ':!S~IfEl'!.t!fJ1f'1J'P.L9 .....:p !,.,..,;.,"::....,.,....,\;.:.
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LEGAL DESCRIPTION
1703 -;) 6'-11
JOB DESCRIPTION
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Permits are non-transferable and expire if\'mrk is
not started within 180 days of issuance or if work is
Suspended ror 180 days.
~fi3bi;fEiacrOR IN..'S, tJffLAT.l. '(iiifQiJif-:;l
2. ;:.. _!!i';:'l;ll:':~";"""":" .;,:,;:J.2.t-~"~;.:1.~-d_ ~li.~:,l:.,';': ~""""f:'-.i,".:'''''~: - .....;_. ...,;,,;
Electrical Contractor. A ~fOnf8f1a"c- I .1:tc
ga.r~f.r r:lv. ~ IJ5'
Phone (pgqt/5"fpO
Address I-))C) I
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City bL~e~1P-
L--!fon ~ (;
101 at..{
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/LI C;;'-1 ~ &
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Signature of Supervising E~ectrician
Supervisor License Number
Expiration Date
Constr. Contr. Number
Expiration Date
JLJ-~L _,
Owners Name g~ . \;;1'1(",5
Address ~'-(t~_hlA ~ ~ I [)
City ~.e<2.ld Phone 4X'5-))'1~)"
OWNER INSTALLATION'
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
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A. ~ ~ ~'Y ~~~~~,~ntial ~; Si~gl('~t:!Y.! ~Jti':'F amity ,pel,:' A":~lI.ing. unit.2,"~~
........._,~_.....___...~,__. ..,..:_.~-.'~,.,.~->-'~.._ ._,., ,.,"'......;.-....-'-0....... ,.__
Service Included
1000 sq. ft, or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19,00
I
$50.00
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P"!<...'6-:.1tr!"l:c~',!:,.~TT....'\~'l'"'::::"~~~.~,.":\,~,,.~: ;'; ""'-"'?":' ........-, _"~'.:~~<-,n"",";.. ~~ ".~,. . '--:: <~-:"M
B. ! :'S'er~:;ic~s,~~:~~~d^~rs'~':I~stan a'tfolil:..A:lt~tati.Ohro1'~Rel~c3 tion: }?~y
~":. -:.:,,,_.~:.:;;;<~:,,%:::J~},,'"_.U....;i-:i!:.\\).~, j,;' ,:",":r~>~.:<: "if::-~'.::.W.l:ffiL'iljL:;~.:,:~'::n~,M.::!J&<.;;:O::.Lr-...n...;
it $ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
--'- " "",,f7" ""-'.-..- , ";W()~~_., :""...."
C. :j!:~!'2.'2'Ql'..r~~~~~\~$ \S'WSL~j!.-': ,;, ' .
,,\C'h\tall~t~~~'il~~~~~
~O ~Q~~~~ ~~~~() $ 50.00
\~~~\~'t\~~~!?~ps $ 69.00
t-'\,()~\lrl~~~\}?~ps $100.00
1>-~~~~.n,~~,~!,~02_y?.!;'.~ee_~~'~a~~~~.'" 'T " ".......'
D ~\~B """'Ii C" 't'~'I;,~",", ;r:>'~1 '",;,,< i<..), 5: 1 "
. ]",~':.'1n_.c,:: ~~~~~~~:l~~;1~::~"1._:..~~ ~~ H~!~I_~~:,~~;p1J.;j< ~~;:::~i_ J,
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/V olts
Reconnect Only
,,--,:';
New Alteration or Extension Per Panel
One Circuit $ 43,00
Each Additional Circuit or with
Service or Feeder Permit ,~e \IOU t<$ 3,00
wreQU,,- , TW
'77 ~~.:;;;nl"r.C1t~fiJ~'HP.orego~.Ll.~I~"'?F';"':.'" ," ....:-.~l
E.. 1\,lVlis,cellan.~p~;Is,.'tm,'j~~I,~e~der..notti!!~I~.lIeil):;;'-1"~ch, Ii\stall.a !ion ,
\~\tow'rtl\B~~~~~~in05~~~p;'95Z~e:..~.I..,- ~..I.,_~
"bu'1WlOWimgation0010t\1l0Ug ",",,,, rull$;50.00
''1 l' ,......tJ ':\11 t~ n\eS V' . r-
;rSLg\i(0utliheLjghtingain CO" .' . .~\",n\10$150.00
, . ..(....,\ {\\i::).\J Ul,,; ''''ote' "IV'- t" .......\~n
(!!iiiiited EnergylResidential Ll't'\"" Nnti ICe$ 25:00
~ ...;"\\I~Qf) thl:' .....'-'..~......,...""'ln \ \oJ )
Llmlteil Energy/Gommerctal "q"D?,AA, $ 45.00
UmOellv' ,.. '" if.p,on... r.
Minimu'ri, ElectrIc'PermiiInspection Fee is $45.00 + Surcharges
r,:-:;~f:;-;"-"-:-' ~:'"r7~r'""::'~:-:~;'1t""'~'7'.'~;';U;j '..-(':':-:. -
4. i .SUBTOTALOFABOVE,,' :.;:<.,c1..,';':"'..
L,"":~:-;^'~'h..:L~-::'~!:"';''';'-~'; <.', . }~-=- _....~.::'".:::1:1
SO
::sS'C
:>00
58~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding Forms/Electrical Pennil Application 1-03.doc
.
.
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:
ELE2003-00061
3/5/2003
3/5/2003
9/5/2003
SITE ADDRESS: 2435 A ST SPACE 10
ASSESSOR'S PARCEL NO.: 1703364101500
Springfield
TYPE OF WORK: Alteration
TYPE OF USE: Residential
PROJECT DESCRlPTION:
MH service change
OWNER! APPLICANT:
JONES BIRDSALL LEE & MA DE
93175 POWERLlNE RD
EUGENE OR 97408
ELECTRICAL CONTRACTOR:
ANTONE ELECTRIC 541-729.6570
4257 BARGER DRIVE #125
EUGENE OR 97402
CCB # 145436 Expiration Date: 04/01/2003
DescriDtion
Amount Paid
Date Paid
ReceiDt Number
+ 10% Administrative Fee
+ 7% State Surcharge
Manufactured Home Service
5.00
3.50
50.00
03/0512003
03/05/2003
03/05/2003
2200200000000000559
2200200000000000559
2200200000000000559
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 am. will be made the same working day,
inspections requested after 7:00 a.m will be made the following working day.
Reauired Insnections:
1 MH Service: Approval required prior to utility company energizing service,
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 hereilL 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,r,eJldable from the
street, and that the approved set of plans, if applj.,c,able, will remain on the site at all times during consn;ii'~tioni
(J"('.'t' >>\\""- \)\\"" {\)
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Owner or Contractors Signature 'X\~x. \'~~ \ ;~~ Date ,,,,\.>I""'eo '0'1 \" \\J.\eS ';'" 9":J\~s '0\
~~ ~y; <..\) "" \ ,v oo~" 'i.'(IOse ~O e \\J. e
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I of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00061
ELE2003-00061
ELE2003-00061
Payments:
Type or Payment
Check
Paid By
Description
Manufactured Home Service
+ 10% Administrative Fee
+ 7% State Surcharge
ANTONE ELECTRIC INC
Receipt #: 2200200000000000559
Date: 03/05/2003
Received By
Check Number Confirm No
djb
Page 1 of]
3/5/2003
10:25:27AM .
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
50.00
5.00
3.50
Line Item Total:
$58.50
How Received
Amount Paid
In Person
58.50
$58.50
..
Payment Total:
cReceipt.rpt