HomeMy WebLinkAboutPermit Electrical 2003-2-13
02/12/03 WED 15:33
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bmitted has the following
ujre specific land use
225 UnH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 .ap1lOO~541)726--3689 C-e.-.
ELEC'l'RlCAL PERMIT APPLICATION Zoning
City Job Number 6LeZoo'3 -D003( Date 2-/r8/D3 Date 0< - tLJ-/- /)3
".,:':', . ..... AuthO~!Z,~P SignatuE~ ~~..
3.COll'lPLETE:FEESCHEl)t!lJiBEWW< '
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1. LOCATIONOFINSTALi'4i'iQJV: "
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LEGAL DESCRlPnON
l'6osoz..z..0
c> Z 866
JOB DESCRIPTION
fUl'Y'.oJJ..-t - 2. U~1s
Permits are non,lransferable and expire if work is
not started within 180 days of issuance or if work is
SuspeDded for 180 days.
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,;CONI'liAcrOR'INSTALriiioN:ONL1.-,'".
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Address
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1'20 mcrn ro e:...
e1edvlCJ
Electrical Contractor
City
Eu.t1~
Phone 3i.fl.f-3S& J
oJ
Expiration Date
-~. ~_M~ A. 'r
Owners Name ~<-~ 5~f"
PO C> (;;< I () 12. ('
Eu.&~ Phone
Address
City
OWNER LNST ALJ,A nON
The in.~ta11ation is being made on property r own which
is not intended for sale, lease OT rent.
A.,J'l~;;"Il~i...,~~~I?Sii1g1e:OrNt~!hFain:il~p~r tl~~!"ljin~uni!:i "
Service lnduded
1000 .q. It. or 1...
Each additional 500 sq. fl. or
portion thereof
Each Manufact'd Home or
Modular Dwellins SeIVi.ce Of
Feeder
$106.00
$ 19.00
$50.00
B. ::.:.:~~~~:.:.~'~:~:f~d,~;~;~;.~~t~~:j4~~~;:Ai"('~~'~;~~~4.~i.~~,~~:~~~~~::,~:,::'
..,.....,'.'......:.'. '. ".
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
.M.inlmum Electric Permit Inspection Fee is $45.00 + Surcharges
200 Amps or less
201 Amps 10 400 Amp.
401 AffiPS6,O 600~s
601 Amps t ~ s
Ove~~~~ ~~
Rts/{,i'l ri.~\S
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SupervISor LIcense Number I oqz,s CO~~~~~au Sen'lces 'or Feeders..-,,", '",..'.' ,,',',:'.,'" '" ".-,.. ,:';,.. '..
. N~' ~'\ ~~'V '?:> ~
10/01/ 0 3 .~'\~~\.~\\.-\.\) \)'?l'li~~ation, Alteration or Relocation
"..~ ~\S r;,,\.\) ~ Amps or less $ 50.00
Constr, Contr. Number Cc..6 qo '2.o{Jl\,~ ~~~\.~\) \)~ 201 Amps to 400 NllPS $ 69.00
3'1/ "\St-I,,\'ij 401 Amps to 600 Amps $100.00
~~~ ~o7 ~ ~n
Sib~lature ofSupel";ising E1ec~ci3n D, ~~2Zfti;:~%J::O;;IS~;~!t~~::""" .
New A1teratio'Oor.cE~le.Gi'\JD J',er ~Mell\l
One Cit~llil\eg 6\)'1" ~~~\0~{>o.~ 9<j~es \)')$ 43.00 If(j.OD
Each'Wddillofl~r-em:3;(Ofd"itli. .X\a', O~e .." 00
. \..... C' .()...... (" .,nv~ Ol\ \. I:.~ '$ 300 eJ .
.:\'\Servire'<lf Feei:ler Remllt . as ",\:J ~o .
r ~\" GIO" l:)"\\j' O~\ a\"" .~\C"'-
\<'~\\O,' _\\~)~ I)\)'\"~. ",?:it$) G" ..,~.~~ !;~~.,('.!\5_, '". . ,
E'~~,~~~(S#h'!i(Cifclid~i>no!-@Cl"ded) -Eudi 'JnstaUation
~O" ~ ",,-, , :\0'; . ''I.eV' ~\)" '''[6'''' "., '
n\>l -JOU \\ r:a\\ a9P "-.'2,7.:
W Pump or irrilf'ation 0\ r:eF.)'" $ ;000
('\C'\~'V .\(\()," 0 ,'n.J .4. ..CO ~ .
'-Si.-10utlint.L!'"htinn , $ 50.00
5~_ _"'0" 1:IO'\IO,.D
T.imjtea:EnefO~y'iResidential $ 25.00
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Limited Energy/Commercial $ 45.00
Owners Signature:
Tn.pection Request; 726-3769
4.~p~~?:t-M'iji;o..~vE:'" "".;:",
7% Slate Surcharge
10% Administrative Fee
TOTAL
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Sb..,,'Cd Drivc(,T:)!Buildin~ FonnyElcetrical Pmnit Application l-03.doc
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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:
ELE2003-00031
2/12/2003
2/12/2003
8/1212003
SITE ADDRESS: 4791 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1803022002800
Eugene
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Add 2 circnUs
OWNER! APPLICANT:
DUCK STOP MARKET
PO BOX 10121
EUGENE OR 97403
ELECTRICAL CONTRACTOR:
EUGENE ELECTRIC SERVICE INC 541-344-3561
120 MONROE ST
EUGENE OR 97402
CCB # 90200 Expiration Date: 03/17/2003
Descriotion Amount Paid Date Paid l) \0 Receiot Number
",,\0 .,,,
+ 10% Administrative Fee 4.60 0211212003 eo.l)\~e ~ U\\\~~QQ200000000000469
+ 7% State Surcharge 3.22 02/12/200~'l'l~ O~eQ,O se'2200200000000000469
Add. Alter. Extend Circ 43.00 ,~2N~t2qq~~ \~e ~eS 0-~e 9S2f02?9P000000000469
Add, Alter. Extend Circ Ea Add 3.00 -<\Ot'021l2(20030Se ~l) O{>.~ ~2200200000000000469
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To Request an inspection call the 24 hour recording at 726-3769:' AU;msp\~~i'&~~~steJ~Wo;;\-rO~~a';n,('$ill'l,;;:mrde the same working day,
.. led aft 00 '11 b ad th 'II . ,,,\\Vk. '\!i'~' - C\,\-vv .~c.v~ \~b" 'i..\\\''-
mspectlons reques er 7: a.m. WI em e e ,0 oWlDgwor,.!.Qguay. .IJ\J '!O\0-\ ~'O\e'. ." ~O
~O~ ..",9'5t; <<\0-':1 0 _."'~,~~ _ \\\\\\"'~,,-tl.tl.l'
Reauired Insnections: \~~91J ;\~ \~~~~~~ C:~~~IJ''O'5e.' ~
1 Rough Electric: Prior to Cover C. l)~'Oe~ ce'(\\e~ \
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 certity 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
furthercertity that only contractors and employees who are in compliance with ORS 701.055 will be used on this project 1
further agree to ensure that all reqnired inspections are requested at the proper time, that each~~dress "' readable from the
street, and that the approved set of plans, if applicable, will remain on the site at all ~'el\'l\r.lfufnstruction.
'i:.'/..?\'r-'i:. \ NI\\ \S ~
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Owner or Contractors Signature ~ v \'i ?'tS\NI\\ \l~W'j'ill \ "~\)()~\::.V \ ~.
\\-\ :\'r\()'r-11t.\) ()'r- \S r>,'O
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CONI \~\) \)r>,i ?
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00031
ELE2003-00031
ELE2003-00031
ELE2003-00031
Payments:
Type ofPaymeut
Check
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 2200200000000000469
Date: 02/1212003
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
EUGENE ELECTR1C
Received By
Check Number CoufirmNo
djb
Page lofj
2/12/2003
3:04:34PMi
City of Springfield'
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
43.00
3.00
4.60
3.22
Line Item Total:
$53.82
How Received
Amount Paid
In Person
53.82
$53.82
.
Payment Total:
cReceipt.rpt