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HomeMy WebLinkAboutPermit Electrical 2003-2-13 02/12/03 WED 15:33 ~001 , 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< ' ."..,..........." .'..' ... ;..." . On. 1. LOCATIONOFINSTALi'4i'iQJV: " 1-/1<1 ," rr-M1i~ ;i,lli'J.; 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. . ., On "'n' ,;CONI'liAcrOR'INSTALriiioN:ONL1.-,'". 2. "'.., '....,.....,. ,..'..:,.,...-,..'.-,.-'.-_...." Address E AAe VJ.e., '-I 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 \.~ '?:> ~ ~\.'V , . "" , ""', 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 ,\~ b 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 /..fb,oo 3 . 2.. Z- '-I. (g 0 58,8''2.-- Sb..,,'Cd Drivc(,T:)!Buildin~ FonnyElcetrical Pmnit Application l-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: ELE2003-00031 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 ....w., .-nO,", -<\'\ _,,'n ~",p, V' .....0- 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 ~ . _~\r.~'. S\\r:.-\..\.., I\" O~?- ."Q Owner or Contractors Signature ~ v \'i ?'tS\NI\\ \l~W'j'ill \ "~\)()~\::.V \ ~. \\-\ :\'r\()'r-11t.\) ()'r- \S r>,'O r>,1.\ Nlt.~Ct.\) 'i:.'r-\()\)' CONI \~\) \)r>,i ? r>,~i I of I 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