HomeMy WebLinkAboutPermit Electrical 2003-6-19
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,_.~ CITY OF S()NGFIELD, OREGON" ,0, ".' ,
mitted has the following
re specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54l)726-3753"'1J1~~ (541)726-3689 l.Dr2-
ELECTRIcAL6~~~~PLICATION ~ Zoning (p_ Zo-O~
CityJobNumber ~u -no.l.5f>ate l .n3ate cKOJ
~ . Authorized Signature
.:3 3f;~orvc;;;~LA:r:;; ~ k10MPLETE FEE SCHEDULE BELOW
LEGAL DESCRIPTION A. New Residential- Single or Multi-Family per dwelling unit.
lIt]";;? 0.:2. 1:::< 0 FloO
Over 600 Amps or 1000 Volts see "B" above.
Signature of Supervising Electrician D. Branch Circuits
~ New Alteration or Extension Per Panel
~ (\ L.w..f)rJ:) One Circuit
-.C.M ~' Each Additional Circuit or with
. 1'_ r' 0 I ~ -t+ Service or Feeder Pennit
Owners Name Orylttb I..:" '7.x. 1..1)
Address l~ '6 0l('vtO) m_lm-I2.J..-E. Miscellaneous (Service/feeder not included) -Each Installatiou
City ~012-
r
JOB DESCRIPTION
~ ~ AW-cL f iLtuJ~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
CONTRACTOR INSTALLATION ONLY
2.
Electri~~1 Contractor. ,~~?:.\~~n 1'(:''''0 d \ "-X' '
f".Iv" r oJIL:'; ~juop'eU by the Or3gon GtL ..
Address,~~;\d:):[~\te.vru~.,:')., .
, : "J;~'~~I~-[)CI" rI rl1roill1J,'i!\''O :h~-C[
CiiYl(1 '," '~~'f~fh6he'3~i)I,9'QI~\sl[
.. ,," ',. . d.:'f. (f\!'Jta:rnDT8!3rJhone
'11; .: .'''. (, '~:~.'" n~"""':l;1 r WPh/ i\'f_~.":-:B.ti:--..
Supervisor Lic~nse Number ~ 'j'1:/ d. 3' S
Expiration Date I 0 - 01 - () l/
Constr. Contr. Number f? 750 b
Expiration Date ., I 1;;< a I 0 5
Phone
OWNER lNST ALLA TION
The installation is being made on property I own which
is not intended for sale, lea<;e or rent.
Owners Signature:
Inspection Request: 726-3769
~ ~ ~~+LJJY-
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
$50.00
B. Services or Feeders - Installation, Alterations or Relocation:
200 Amps or less / $ 63.00 03 ^ cSO
20 I Amps to 400 Amps $ 75.00
NGlfIle-E'I's to 600 Amps $125.00
TI-i99Iptl/WM\l gjqAn.l11!'~PIRE IF TII[ \'/3rt~63.00
ALqYMj1,q22~'lJl'flX.q\tsrHIS PER/.:I-:- I:) ;,'0 75.00
cdMfR~p"cl:~nI3'R IS ABANDONEu run 50,00
o<JY 180 DAY pFRlfln' .
C. Temporary ServiN-s or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
$ 43.00
$ 3.00
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
(" 2 C)D
4~
<-o-~o
~~ -:-u-
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Fonns/EJectrical Pennit Application 1..o3.doc
G1 (\ ~ CD':;'
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
JoblJournal Number
ELE2003-00 153
ELE2003-00 153
ELE2003-00153
Payments:
Type of Payment
CreditCard
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liifilrt. .'~'"..'."'.-"= "~.'- " i..
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Receipt #: 2200200000000001088
Description
Perm Serv/Fdr 200 amps or less
+ 10% Administrative Fee
+ 7% State Surcharge
Received By
njm
Check Number
Batch Number Authorization Number
Paid By
MY ELECTRICIAN
000101 019722
City of Springfield Official Receipt
Development Services Department \
Public Works Department,
I
Date: 06/19/2003 1:20:23PM
Amount Paid'
Item Total:
63.00
6.30
4.41
$73.71 .
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71 .
.
.
,
.
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City of Springfield
Electrical Permit Attachment
fii"
Status: Issued
225 Fifth Streel
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00153
6/19/2003
6/19/2003
12/19/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
3368 GAME FARM RD
1703221201913
Springfield
lYPEOFWORK:
lYPE OF USE:
New
Residential
PROJECT DESCRIPTION:
Service Change
OWNER/APPUcANT:
ELLIOTT THOMAS G
3368 GAME FARM RD
SPRINGFIELD OR 97477
WOODS ELLIOTT EVAN
10 UNKNOWN
ANYTOWNE OR 00000
ELECTRICAL CONTRACTOR:
MY ELECTRICIAN INC. 5417291454
32316 RILEY LANE
COTTAGE GROVE OR 97424
CCS # 87506 Expiration Date: 11/20/2003
Descriotion
Amount Paid.
Date Paid
Receint Numher
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServlFdr 200 amps or less
6.30
4.41
63.00
06/19/2003
06/19/2003
06/19/2003
2200200000000001088
2200200000000001088
2200200000000001088
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.
Reouired Insl)ections:
1 Electric Service: Approval required prior to utility company energizing service.
By Signature, I state and agree, that I have carefully examined the completed appHcation 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 herehL 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 appHcable, will remain on the site at all tImes during construction.
Owner or Contractors Signature
Date
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