HomeMy WebLinkAboutPermit Electrical 2003-3-18
r
- b CITY OF SI"r<.INGFIELD, OREGON :.""
.-
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTlUCAL PERMIT APPliCATION
City Job Number (g..C:i:OOJ -OOO7~ Date 03/8' 0 3
~ Amps or less
,~0~1 Amps to 400 Amps
",e /)
~,,"' ,,,,<:, 40 I ps to 600 Amps
Q'-''S..'v
.~e ~e~' A s to 000 Amps
{!' ".
Phone 0,-:''<:) ",e 00 mpsIVolts
e'" ~~ ,e"':~ fl/ 0 ct Only
~ ,0' <:' ,.-Q'/-
I ~q e" v'
Supervisor License NumberJ\4 .:n"'~/) /)0 ",,'
- '4,\y~,v~. .~Q-
61 .(.,~ ,'C' ..).'1i 1-0~ 0
Expiration Date V 1,O~_t'\o ~.,......:>\
~y / cb,r$~-
~0 00
",7> ,(,"\;
. ~"~
V-'
,,-0
..\. ,<-...\
~.....\)~".. ~,-\
Signature of Supervising Electrician #e~ 0'" 0'-'~\;)<:i'\_
elS. e<:$ e<;; ~ 'Q',
~ ~ 0" qJ> '?l'? ~eC; New Alteration or Extension Per Panel
_(:>.'\?; .-;s.e .~eC;"~<t-,.,.,,.;;).('o"'~ 0'" One Circuit ~~ 43.00
~e~- O'Q~ f.>e' ~- 0\~':!P~':()~ Each Additional Circuit or with &:.. ~ ~,N-
--r::~~,\)~~, ,I; \~, 0 ,d.~'" '~0C; 0,e o~~ servt,'ce or Feeder P, ennit, G ~~_ '~,' ',' \"$, 3.00
Owners Name "A{l)r/~ ,\,,\ 1t;i'lA.f':t:.~ :<;;~.j?'.' '.. __ ~~. _~~'$'. ~\.~(;:)~ _._
Address L;\~~~~~~G:8;~iip.~~~f~'t\~y"n-<:J E. r Miscellaneous (servi~a~~'1~1~IUded)-EaCh Installation I
L y...,'0.... ,.~o:,!:..:r _~ v.^~...Ir;(lrg,1: 5' i ,...~'v~ a. '\~ ,...:~<v'i:j
City ....)ye,.Ni.o.,.(.i.flJ')~ ,Plione" ,,\H";t~.i I", '1 Pump or !e!gat!.'\Ro'(' ~~~' ~'Q'p $ 50.00
~0""O'i!"'4..0v -;s.e">:s-e .,c;....-- Si~~t&li~l>~n~ ~ f.> ~. $ 50.00
OWNER INST;(L!.:.~fT.~9~e",0~~e" L~\l~~ll~~~ $ 25.00
!he in.stallation is ~ing~~td'~ on ~roperty I own which Lima:~~~'8~rCial $ 45.00
tS not IOtended for sale, lease or rent. Minimum EI~'f\JII,'Vmit Inspection Fee is $45,00 + Surcharges
\~
4.1 SUBT01'AL OF ABOVE
1. I LOCATIONOFINSTALLATlON
;: t./3Y7 &L-Dt:-1Z.5a.R.. 6.,-
LEGAL DESCRIPTION
J70Z 3z 3l.( 6.f3t:>O
JOB DESCRIPTION
~Nff~L+
SMv';c..t"'
Permits are non-transferable and expire irwork is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2. I CONrRACTORINSTALLATIONONLY I
Electrical Contractor
Address
City
3. I COMPLETE FEE SCHEDULE BELOW
A. I New Residential- Single or Multi-Family per dwelling unit.
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. I Services or Feeders - Installation, Alterations or Relocation:
(
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
~-C>
Constr. Contr. Number
Expiration Date
/
(
'-.
7 own&t~b#
/
Inspection Request: 726-3769
I Temporary Services or Feeders
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D, I Branch Circnits
$ 50.00
$ 69.00
$100.00
7% State Surcharge
10% Administrative Fee
-:50
') 50
5"00
c/; S8)~
TOTAL
/
Shared Drive(f:)/Building FonnslElectricaI Pennit Application ).03.doc
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfiel~~egon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00078
3/18/2003
3/18/2003
9/18/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
4347 ELDERBERRY ST
1702323405800
Springfield
TYPE OF WORK:
TYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION: Reconnect service
OWNER! APPLICANT:
MICHAEL JOHN W & LEESA I
4347 ELDERBERRY ST
SPRINGFIELD OR 97478
ELECTRICAL CONTRACI'OR:
JOHN MICHAEL 541-744-9654
4347 ELDERBERRY ST
SPRINGFIELD OR 97478
CCB # Expiration Date:
Descrintion
Amount Paid
Date Paid
.Receint Number
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
5.00
3.50
50.00
03/18/2003
03/18/2003
03/18/2003
1200200000000000847
1200200000000000847
1200200000000000847
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 I nsoections:
1 Electric Service: Approval required prior to utility company energizing service.
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 Sp'ringfleld and the laws of the State of Oregon pertaining to the work described herein. I
further certify that only contractY~<~i1'l!;~:;;j,loyees who are in compliance with ORS 701.055 will be used ~ this project. I
further agree to ensure that all'?equire(..ins~etiOits are requested at the proper time, that each addre~'0'i'r\~dable from the
street, and that the approved;r.$;j(pi~n~r,ii~plicable, will remain on the site at all times during \~~~~c.ij;),t
,,1Jo~;;.~ -:S!~J O~. 0' ~\)' ~O' ~ \'c ~t.,,\\ '\ ~
^&' "'~~ O'~v ~ ~>S' ~~.(.s>fIj ,.,.~~ ~y~\";') '\:~
Owner or Contraetors,&gnattiie~O- ,0"" :,,0'" ,~0' ,.:>-'ili-' Date 'X-~\,\, \\.'(..\':J ~'V'V'l!;,\"'"
~-;"<:>OO~~"(;:,:f.J0~0~$~~; ~,\\rv~~~\ 'O\\~'V~~ ~'Q'f-l
,,;"'~00 v<b"'~1;;j ~.:if ~~ 0'" ~~'!; \\~\";) ,?y; o..\t~'V C"\ 'V~ o..\'V'V'
,,' <.: !-' \:)1:) 0 ~0 ~) 01 \" '(..'V\' R.~" o't)'
"<~ ~:i .r~,o ~l; #> (f d''li 9:>r:S ~\\'\ ~~~ ~ l
".0 $~.:t~0'>~0 ~~0 ~~" ,,\)~ \'O~ 'V
,lll 0 ~. .~O; ~,O ~flj ~~
'<$' ~q) #' ~0 vIQ
I;;j CO ~
",'5
I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00078
ELE2003-00078
ELE2003-00078
Payments:
T)Ile of Payment
Check
Paid By
Description
Service Reconnect
+ 10% Administrative Fee
+ 7% State Surcharge
JOHN MICHAEL
Receipt #: 1200200000000000847
Date: 03/18/2003
Received By
Check Number Confirm No
djb
Page 1 of I
3/18/2003 [
I :34:26PM.
.;'"
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
50.00
5.00
3.50
Line Item Total:
$58.50
How Received
Amount Paid
In Person
58.50
$58.50
..
Payment Total:
cReceipt.rpt