HomeMy WebLinkAboutPermit Electrical 2002-10-9
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';-"""1<j~ 225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
ELEC . .'-.lCAL PERMlT APPLICATION
City Job Number ELP"ZOOZ -OO{O~
200 amps or less $ 63,00
201 amps to 400 amps $ 75.00
401 amps to 600 amps $125.00
601 amps to 1000 amps $163.00
Over 1000 amps/volts $375.00
Reconnect Only $ 50.00
\\t. ~O,,~
C. Temporary Services or ~m~ \f 1 \S ~Q\
~ij1l~ion :M~~:1~<ft~\'t \\
,\\\S ~~~s~ie~~ ~~~~OQ~tO fO
~U1~'M"l\1i2'S)tQl ~es
CO~~cffi ~~'t mps
~~"OO~6"O0 amps or I 000 volts see
"B" above
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Owners Name r~D -to ~l+~
<{ New, Alteration or Extens~~,\ger Panel
(/7>. 7 l' I ..-71"{" , i/' L eS ~ . '[\~ I LI3
Address Q U ,...{ I f-.I VI One Circuit ~ {e~u\{ 0'" \,)\\\\ ~\"\ _ $43.00
~ h ' . ClO'" \-0: e o~eg e Se\ \0", -
c', Ph -1\.J 1-\/'} 3 t::: \E" '(',xeKdd"f''\I\~1 n'-C <;\{ ---nO sO .
Ity ( one I 1 tJ P'. I -(\0' ae 1 "'- 'I ,Iona rutrcUlt.,gr<'Wlt et.v:lCe
-d '\~\\ 'nO''''-. c:.e'V" 01\.\,0;' \ SV}
OWN~R INSTALLATION r'\:;::\ ~ec..or~lfee(ler\l?er.mJtUI'\'(\ r "'e {U\e $ 3.00
po. ~ {U '-' e",\el. \~~o ,':) 0\ \\, "'o"'~
'\0\\0 .;;':)'" C A J\O'\O _",o\eS ~B\eQ\' ~.."n
~1\t.E':':cN1lsseHaneous..(S,erMcel feeder- not'\lOcltiae(J)
I~ \'~ Sv"'v - ri':o." H>.' ~.. ...\:\: \,-
~001\.~ 9 ;..~i!qh')insta.lt\ltiol1'~~;\\\~ ,...0 '\
'f\ r "oup" ...v~\, '.u~\\ nA/>,,'
.. nO,' ~J!mB(Or frngagon nfj,?;.v
00-:1 r'S""~/n- QI' {I::;~, rt.. ~.,","
",\\\r.~ IgW\.:o,ut me brg~!It1n~
c.,,\\ . ~u\'" . " "\ -0'
u~'OeLJ..md,t~,~Energy/Res
'" Lui:uted Energy/Comm
1'11/1V rec- '1,;-9.2...
5. SUBTOTAL OF ABOVE
7% State Surcharge
8% Administrative Fee
3. COMP~ FEE SCHEDULE BELOW
I. LqCATIO)! OE INSTALL~.TION, " \~e\o\\~c;,e
(p 3 -, l/h Cur\ leV\ n I tt t 81 \1 l . \eO'\'~~~~esidential-Single or
"1 soJY;)~\e~ s~eC\ I-Family per dwelling unit.
j., , ."s oJ\' .
LeGAL DESCRIPTION ~~c' \ ~e~ Ser Included:
170 376V3 ~f(jw {\o 011
. e \0 .,,{\o - r. -
~\\ {\~, '"
JOB DESCRIP1jION \ " 1-~~~-Jt'; l..c:p\{\Q"
! \f\ \(){Jctw CC)y"V Y:'c.n { JII\(
V '~, {\'3-\oJ~e
Permits are non-transferable aQXt~xpi"teo s,g
if work is not started within 180~~\
of issuance or if work is suspended for
180 days,
000 sq.ft. or less '
Each additional 500
sq. ft or portion
thereof
Each Manufd Home or
Modular Dwelling
Service or Feeder
2. CONTRACTOR INST ALLA TION ONLY B.
Electrical contractOlCAS 8e6h-iG ~ .
Address f. O. ~~, 14((2- .
Cil)t.~in5tkld Phone l~l "'21310
Supervisor License Number ~q ~S
10 lllOL(
Services or Feeders
Installation, Alterations or
Relocation:
Expiration Date
Constr Contr. Number 3<64-01
Expiration Date Cf lloYf-
Signature of Supervising Electrician
~-
D. Branch Circuits
The installation is being made on
property 1 own which is not intended
for sale, lease or rent.
Owners Signature:
L()
-:J /F'
')'60
TOTAL
:>r 7 J
~
Items Cost
Sum
$106.00
$ 19.00
$ 50.00
$50,00
$69.00
$100.00
$50.00
$50.00
$25.00
$45.00
LIB. DaJ
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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:
ELE2002-00105
10/9/2002
10/8/2002
10/9/2002
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
637 CENTENNIAL BLVD
1703264312100
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Inspector corrections
OWNER/APPLICANT: ELECTRICAL CONTRACTOR:
ROB RITZDORF
88041 TIKI LANE
SPRINGFIELD OR 97478
541-747-8239
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
Cashier
+ 7% State Surcharge
+ 8% Administrative Fee
Add, Alter, Extend Circ
Minimum! Adjustment Electrical
3.15
3.60
43.00
2.00
10/09/2002
10/09/2002
10/09/2002
10/09/2002
1200200000000000038
1200200000000000038
1200200000000000038
1200200000000000038
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dib
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To Request an inspection call the 24 hour recording at 726-3769, All inspections requested before 7:00 a.ill. will be made the same
working day, inspections requested after 7:00 a.m, will be made the following working day.
ReQuired 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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