HomeMy WebLinkAboutPermit Electrical 2003-4-3
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SPJ'lINGFIELD, on 9N71
(54 Ii 726,3753
FAX (541 i 726,3689
www.ci.springtiefd.or.us
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DEVELOPMENT SEHVICES DEPAIi'fMEN'f
April 3, 2003
Leslie Kelley
1050 Kintzley Avenue
Springfield, Oregon 97478
Enclosed is the original electrical permit to raise the mast at 1050 Kintzley Avenue,
Springfield, Oregon.
When you obtained your permits, we neglected to have your sign the permit. Please sign
the permit on the indicated line and return it to me in the enclosed self addressed pre
stamped envelope, I am enclosing a copy of the permit for you to keep for your records.
Thank you, and if you have any questions, please feel free to phone me at 726-3790.
G:
Lisa Hopper
Building Safety Supervisor
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cc: David Bowlsby
Enc!.
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,'~ CITY OF SI-'KINGFIELD, OR~GON ,
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726.3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ECC;:'cX,:;. (A";c'.) ~6 Date () 4/L~/ / 0 ',~
1
3, COMPLETEPiiEsciiitij'iiiJi'jjELOW;;'" 'I
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JOB DESCRIPTION
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1/111 A'SJ
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
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'CONFRACTOR'INSTALLATlON,ONLY',
2. t":'J,>:~#~':;":~$'.~'~:'!:..:'.;"'"c'''';\'\'',,.;''''i,'''- f"-'":,'~' '~",:,:r:;~~~
Electrical Contractor
Address
City
Phone
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Supervisor License N u~ber "iL--
b
Expiration Date ' \ ~
D'
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name
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Address
City
',pF0
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A, ~~iji~sid~[ii~{=:~i';gle'\o.i:'M~lti,~~l'ii!;j~~~~~iil~~:~rit"
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular DwelIing Service or
Feeder
$106.00
$ 19.00
$50.00
If &"'r '.---"- ')~-~~~"":~'" h_ ':---: ~'" r,--,,-:'-"" ".~ ..--.....-----"'...,'-' '.. ,
B. ;;:,S~r~' jt~~r~~:~f~!~.~:i:s ,-:-;~~~stall,,~.t~o";':Alt~~~t.i?,~~ '_~r ~ R~!ocn lion: '
l:..t:.;....,;~i__:;,.o;;..,.......,.--"'_,.____,_"__~..,l. _..._........... ", .-, .',' ~ ' '.~, ,
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125,00
$163.00
$375.00
$ 50.00
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c. ~'Temnorar.:v,;Ser.vlceslorJFee(lersroP.\"'l"-~~;~I;'~"""~''#;< ,...'~o. Ie)" . . I
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Installation, Alteration or ~eIO'i:ati9it\\' {i'
'u~ \<::P ,\0 '..
200 Amps or less \o.,j' O~"l" ",!>e" ,,\)"$ 50.00
,'~'\ \"\.~ ,"\~ 'bt.... "('
201 Amps to (l.9ct-l\'l:\IJSC ,\)W"" <'1':1 ,~s $69.00
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40 !,~,?ps',t~BqfI~~\'l1~; ,~\\(}\',,\ .\",(', ,,~(\($ ~OO.OO
Ove ,6,Od-'AwpS"o' 1000'Yol'see "B'~<a\'~'vt<\\()
..', 'Iii~"im,~--~~~"""",~,\j\~",,,,c,..;, ,J.~'''''''"''''''''''''''''''''''''"''''''''l'''-''' '"
'n \0 '.....~,," t.,\,r.:'j;ot''i:;, '~\~~~~'r.>"'\''\~:i'''.jI':~v;""*~,,,.:tf, \k~"<!'Ii"!;i;Vii';l:,,li: !,." \.,: oj', '- '.:
"'~'\ P.~~c~~'~\,~i~~o ,'~~~'~o;:~'\~~~\~;&t\\~;~~~.~,i~~;~'~:i!:::,.;:'-:rr.~;:'"';.t.A
,~l, '\/e~)A~!e~,filinlD~lI:XtC1!~/ti'! r,,~f1.Pai1el '
:l.J .0 v"G ()'(,I.:< .(\.....
\'Onlll'C;;ircuil, \0,' \-", , <;>,", $ 43.00
,.\ '",' ,.\",,-., ...,,'.' ',~ \'"
Eac"';\i1a~~iorlaJ'9rcuit or with
Service <ir'Feede,'Pennit $ 3.00
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l'i.w,~~~(;,~~"':;:;;~~~.~~~i}t:F':"~~~'~":""~:';f.:H>'''''';,,::;~"'t;,t".
E. al~I~E~I)MIi,()~s((~~ry,i~et,fe'e,~er,'il(it ,i~c,liige~)b,E,~,ch(1 n~tal'a tion"
,l~.~";.;:;..;I,.t"""'-#".......~iW,........;-;;.;NI.~,,,.,'.~.4,~,,'__#~il.,...ri:;.;:;:J:;,,..;,'j;;:'..""..,..'oI_"...'l>.,..., ....~". '1"," ,~
Pump or irrigation $ 50.00 ~\L
Sign/Outline Lighting ~ ~~~ o\\C~
Limited En~e({\~re~ntial \\~\ \. 't.'1-\'\~@.\l.til1'l'i \13 ~
Limited En ~<s~\11 ~\>\I)t.?- "\ \"\~,,~ far.
Minimum ElectriJ ~~'i\\~~~~ ~~45.00 + Surcharges
- , -,- .-- ~- c.~~\;.v."oc.Q\tits... _, .
"-"",. '" , ' .. ,\,.1'0 ~~\,.,,\ ',','" "-0
4. SUBTOTAL ~">", ':." .>
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7% State Surcharge
10% Administrative Fee
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Shared Drive(T:)/Building FonnslElectrical Pennit Application 1'()3,doc
TOTAL
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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:
ELE2003-00096
4/1/2003
4/1/2003
10/1/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO,:
1050 KINTZLEY AVE
1802062403700
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Raise masthead
OWNER/APPLICANT: ELECTRICAL CONTRACTOR:
LESLIE KELLEY
1050 KINTZLEY AVE
SPRINGFIELD OR 97478
lESLlE KELLEY
1050 KINTZLEY AV
SPRINGFIELD OR 97478
CCB # Expiration Date:
541-746.0522
,Descriotion
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
Amount Paid
Date Paid
Receiot Number
5.00
3.50
50,00
04/01/2003
04/01/2003
04/01/2003
1200200000000000918
1200200000000000918
1200200000000000918
To Request an inspection call the 24 hour recording at 726.3769. All inspections requested before 7:00 a,m. will be made the same
working day, inspections requested after 7:00 a,m, will be made lbe following working day.
Reouired Insoections:
1 Electric Service: Approval required prio~to utility company energizing service.
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By Signature, I state and agree, that I b~ve carefully,'examined the completed application and do hereby certify tbat all
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information hereon is true and correct"and'I furtfier,:,certify that any and all work performed shall be done in accordance with
the Ordinances of the City of, ~iif!i~g!i~IJ;rid\"e.!ia~~iif the State of Oregon pertaining to the work described herein, I further
certify that only contractQf~)an!l:,J~p.l(lY;es\~h~ a.r~P;~,,!;ompliance with ORS 701.055 will he used on this project. I further agree
to ensure that all requir~d'in~ectIJ"\s,a'fe'fetjutsted:at~hC'proper time, that each address is readable from the street, and that
h d 'f' "I AU)'r ' 'I"~ .!'Iv~ 'II'J .'p'y '~th'- 't t II t' d' t t'
t c approve ,set,o P. aDS, 1 ISPP' lcau e,.~Vl remamloo e SI e a a Imes urmg cons ruc 100.
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~_\\O~ _"O~_ C\'\)V ~'C\?Y~\'i;\O\~ ,~~"\",W><" -f \~ \~t. " ~a\
Owner or COBt~'C~rs:Sig,;~fu1eoO~\e" eQp" :o~l-'" pate ~\. t.'1.\,\T>~t.?>~\ \ ~Q?>
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Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00096
ELE2003.00096
ELE2003.00096
Payments:
Type of Payment
Check
Paid By
LES KELLEY
Description
+ 10% Administrative Fee
+ 7% Slate Surcharge
Service Reconnect
Receipt #: 1200200000000000918
Date: 04/01/2003
Received By
Check Number Confirm No
djb
Page I of I
4/1/2003 t-'
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. .
9:12:04AM .-
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,
City of Springfield"
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
5,00
3.50
50,00
Line Item Total:
$58,50
How Received
Amount Paid
In Person
58,50
$58,50
...
Payment Total:
cReceipt.rpt