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HomeMy WebLinkAboutPermit Electrical 2003-5-14 ( '\ /' , CITY OF S\_~.ilNGFIELD, OREGON l) '--........ ' , . . , r t as submitted has the tollo . 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAXi:p(54UI.26_~'I.'89not require specific land us;Jng ELECTRICAL PERMIT APPLICATION ZOning ~I"l. City Job Number ELEd003- OOI;;;l~te s-N-03 Date_ '-'''-03 I. LOCATION OF INSTALLA110N 3. COMPLETE FEA1P~"Ci1'kfj'i'fltg'Bffl,~~" "1'<0 .z,~-;)tf T)o~t/lc:. DYtV't L\%~?~fNO~ JOB DESCRIPTION ~~ ~\V'~1\ Yl0clcLlo Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. A. New ~esidential- Single or i\1ulti-Family per dwelling unit. Service Included 1000 sq. ft. or less ' Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or , F.;e.aerENTION:Url:lYu" ,dill I"':' "'~- \Ill" ~$50.00 f' ,iow rules adopted by the Oragon UtIlity CONTRACTOR INSTALLATION ONLY BN rJervices.orrFeeder., =-, Installation', Alterationsror Relocation: 2. t 01UICtlUUlIVOIU\;;I. I....-'~ ......~. _.- - , m \ I I (JAR 952-001-001 0 through OAR 952-00 Electrical Contractor ll.ll( f ~c\-\11 ,Cta 0 iC>C" 2?~tJ~o\'f l~a'y obtain cople!' "I thp ru$,63.00 D -I / ~~I~WP'~g~~1g0,;~~lPJr. (Note: thp teleoh$17.5.00 Address ~ ;:):~ I G; "-.\\ e" \..6--v\ Q 4Drtu'W\'JJ~f'laP~tj\Jl1I)~egon Utilitv NotificSli25:00 ('\ ~ UCf -1~5"c[ 601 Amps@E!PIlQrAml>s900-33?-2'i44). $163.00 City \.'f) &~e Phone !If Over 1000 Amps/Volts $375.00 Reconnect Only $ 50.00 Supervisor License Number 3CJ;;l.:3 S C. Temporary Services or Feeders Expiration Date ~ f1: orA. Installation, Alteration or Relocation . 8' 75! 0 6 200 Amps or less $ 50.00 '"' ........-- Constr. Contr. Number ~_'- '~~:F-- 'i..J;l, 201 Amps to 400 Amps $ 69.00 .~::.-~,,:l.. I NQlP~OC",pst0600Amps $100.00 Expiration Dat~ I - ?-o- 0 3THlSvg@OMA~~&Uo@il(\l~J.fe 'f.~~"~,Q!lK S. fS" EI .. MITlL'''\rD'7~n.Jt~II:1t'C R THIS PERMIT IS NOT 19nature 0 upervlsmg ectnc13n tu. rB mlt.. ~u+tUits 9J COMM~CED OR I~ABANDONED FOR D ('\ f\ tl '\ <1 ^N~ei'i ~Aapf;JH\lioo~ension Per Panel r ~ /I\.J l...U.J./ \ One IrCUlt I $ 43.00 . (Each Additional Circuit orwith ~..... ,-\....a Service or Fe'eder Permit Owners Name k+'\ Iii I\J 't \ l' CJ..( ~'f (y.,S&"f\. Address 3 3d\.! J)CUI...~S L1, City, ~ r\ Lf3 . cD $ 3.00 E. Miscellaneous (Service/feeder not inclnded) -Each Installation Phone Pump or irrigation Sign/Outline Lighting Limited Energy/Residential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 OWNER INST ALLA nON The installation is being made on property I own which is 110t intended for sale, lease or rent. Minimnm Electric Permit Inspection Fee is $45.00 + Surcharges 7% State Surcharge 10% Administrative Fee ~.CX) 3.1~ Lj.~ r:; 'd., w;;: Owners Signature: 4. SUBTOTAL OF ABOVE Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building Fonns/Elcctrical Pennit Application ).03.doc .,-J" . . 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: ELE2003-00122 5/14/2003 5/14/2003 11/14/2003 SITE ADDRESS: 3324 DOUGLAS DR ASSESSOR'S PARCEL NO.: 1802062103300 PROJECT DESCRIPTION: Spa circuit and hookup _ ., ~pr\Qgfj~ld; you .oj ^""'-ENTION:lT1f-P-EJOF'WORK:egonl'i.eil:;ty ~'l ".\...~t:llll 1\ IN rules adopThlPE OF USE:. are ~.!:~iiIeritial to ~. enter. Those rUle5 -00', Noti\lca.t~~~ ~nU)f\1 0 through OAR 9~~~~ h in \E't'Ec"fIiIGAl1t€0N'fiUcToR;,one OC~~"IEl1~dTRTC~~!~N~~'~ii;jt~ Not;liC85~17291454 \3~~1!ilRIl!EY{1fANE'~~~ ""0_2344). <:;OTTAGE,GROVE-OR97424 CCB # 87506'-' Expiration Date: 11/2012003 OWNER/APPLICANT: LARSON BRIAN R & TRACEY L 3324 DOUGLAS DR SPRINGFIELD OR 97478 Descriotion Amount Paid Date Paid Receint Number + 10% Administrative Fee + 7% State Surcharge Add. Alter. Extend Circ Minimum! Adiustment Electrical 4.50 3.15 43.00 2.00 05/14/2003 05/14/2003 05/14/2003 05/1412003 2200200000000000843 2200200000000000843 2200200000000000843 2200200000000000843 To Request an inspection call the 24 hour recording at 726-em~1I inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will "ffl~~~~~~lf~~M~er~j{jgllW'IF THE WORK t. ._, 1--'--- "..--- -"'~ --.,,/'- Ir' f'''~ nv II Vlllil..L..t., ''/ULlL..ll Il1lV I L..11nll) ...., lIVI Reouired Insoections: COMMENCED OR IS ABANDONED FOR 1 Rough Electric: Prior to Cover ANY 180 DAY PERIOD. 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 Page 1 of I 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number ELE2003-00122 ELE2003-00122 ELE2003-00122 ELE2003-00122 Payments: Type or Payment CreditCard 5/14/2003 City of SpringfieJd Development Services Departme~t Public Works Department. Official Receipt Receipt #: 2200200000000000843 Description Add, Alter, Extend Circ Minimum/Adjustment Electrical + 10% Administrative Fee + 7% State Surcharge Paid 8y EDWARD N GUIDRY 9:27:03AM Received By ddk Date: 05/14/2003 Amount Paid Item Total: 43.00 2.00 4.50 3.15 $5Z.65 (;heck Number Confirm No How Received In Person Payment Total: Amount Paid 000068 000002 52.65 $5Z.65 Page lof1 . . cRcccipt.rpt