HomeMy WebLinkAboutPermit Electrical 2002-10-14
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'.. r'225xlFTl-isTREET i- -\ i--if' .!f' i' \, E~E.CALPERMITAPPLICA1;ION~~:.
: ,-<, "SPRINGFIELD OREGON974771 ..J ,I 'I'; : - '1:::./r-
:\"0"_:' I., INs,r:EcTION REQlwST: 72G=~~6f:'l 1 c-:-j, II' I I'Ci\y 'Joh ~umhel' c'i-c;- 2--I!lU L - 1701/5" .
""-\ I. .~F\CE 726-375?, .' :! . L !'...:. ! il,:, ~, :, '
;C:' ..J ':! ; 'i ! I ,. . \ ! \, ...J ,r ,L. :3 ',COMPLETEFEE SCHEDULE BELOW
\ ;...r I '1. LOCr\TION9F~N~T~. ATI~)N 'L,:jI ::, j I. .' .
"''--'' ~-- H r.'i'1 ...IL" I;_,.o~.:"" '. / . P' J --'--, 'A'-N' 'R"d "I S' I .
-, . I'"") t-a C ~I VI ~ n. cwO CSt entia,.; mg c or-- -_. <~- - --~ -~~---~.:
Multi-Family pel' dwelling unit.
Seryice Included:
". 2. CONTRACTOR INSTALLATION ONLY B. Sel'Yiccs 01' Fccdcrs /
~.:; ~::;.:; .{" .. /n :~ \ ' "-1 r, l /I " Installation, Altcr,.tions or. .
;.'!' Electrical'so.ntl'~lcto~~r.,~(j <:/'(1'1 l: {'c'11.tA/ Oft<.f .r"c.-RcIoeation / .'
'-;'f, Address 425'1- .! glf~ff.-if #- \ 2!~"-.'- 200 mnps or les/ - ~ $ 6:i.0~' (,3
! ".1 . I '-'
I ,', ' , '1' ,,- / . , . " 20 I amps to 400 amps $ 75.00
:,'~i CityGvl5il1P~ r ,- p,hone-'7J'q'~&5n8 ' ' i ':~: ~~~~::~~~~~l~:~egonlawreqmr~yt~~
t'~! Supervisbr Licen~e:Numb~r "too 1-5 Over )OOil\:i;\1\Pl}101f8oPtedbYtheUIt:l~~9otth-
'. :1:<.1 ;~Piralli~Date \Jlofln~:,,:' .Teml~oe,~,;ti~iS~~~~~:~J~ii~~K~:~~~~~~
,..Constr ContI'. Nllmbe~J2:I.l;q .5 r; Installati~g\'l!t\(~t1dn1illl R!lnc:~Jlte:tne~te\ephO~ n
! " -~ ~ calling the center, o~ UtlllWNotitlcat 0 "
"::'--'EXPiration~~te 4'--':';(J.<,' _, '200 a'\'ill1WrJ&tslorthe.oreg ~,OO_'
, " '. '. ( ~_,:,,' 201 amps 10 40Q)ultl>~ns 1-800 _ $69.0q _
Signatui'c'o(Suflcrvising Electrician ~--':"~Oy~r 401 to 600 amps ' $100.00
. . ,-.. Over'600 amps 01' 1000 volts see'
~sj/~-JL~ _" "B" aby: '-, ORK
'" D. Branch Cii1'1\lt\CE: .' ' , piRE IF 1HE W
own~I'SNaJllci!1lc:Ji",r:;t... If fl1 ~ Ne\')IAPtl,ffi~o~eR'ii>\ffnSj~jJ>,PhVV\\<b'PERM\1 IS NOi
\ 'j' i RI1.EO UNDER {)[)t:jI:f\ fOR
On'ecinNi\iHO cNCEO OR IS i\Bi\N"$fIJ:rm _
, ,', COMMI' V PERIOO,
Each Ad<l\\illi1a11~J~nRJhr with Service ,
or Feeder Permit -L $ 3,00 ~
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LEGAL DESCRIPTION
/ 7/J 2-(') 2- )
00/ Of)
Items Cost Sinll
$106.00
$ 19,00
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, $ 50.00
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JSlBDESCRIPTION ~. 1000 sq.ft. or less
\(YlIl' (cAr~lt6; e 0 I win r j e! as submitted hasl!!l1ClPl'lll!liltllltlal 500
j '-' I reqUire specific taM usa rt'
1,_ approval. sq: n or}Jo Ion
Permits are non-transferable and eXPi':fnin L.J) It- thereof
if work is nqt'started within ISO days 9 If)....... t:.<:iC1l1Vli:lIlu.:'d Home or
f. "'f k' nata - LII'-oZ-.., ~, ~ II'
o Issuance or I wor IS SUSPCI aeu JVl ' , I .Tt:__:_::-__ ."C lllg
180 days. Aulhonzed Signature '7<w Service or Feeder
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Add rcss
Cit~\\f'\~I<.eli Phonc'l~l-Il.o"
OWNER INSTALLATION
The 'installation is bei~g made on
property 1 o\m which is not intended
for sale, l~ase or rent:,
" $50,00
$50.00
$25,00
$45,00
E. I\lis.ccllancous (Scl"Yi.ccJfecdcr not included)
,Each installation
l ,,'-.'.
Pump orlrngatlOn
Sig~I!Outline Lighting
Limited Energy/Res
Limited Energy/Comm
)
Owncrs Signature:
. .
/~6jt/Q) ~y:IO .
('0~2 ~A-,
I\'linimum Electric Permit Inspection Fee is S45.00 + Sl,ll'chal'gcs
4. SUBTOTAL OF ABOVE
70/0 Sta,tc Surcharge
80/0 Administratirc ~.cc .
(t7/0,DO
4-,,2-
~.~6
-
75.5'0
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:
ELE2002-00115
10/14/2002
10/14/2002
4/14/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
757 LAKSONEN LP
1702352300900
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION:
Service change and one circuit
OWNER! APPLI CANT:
SHIPMAN DONALD S JR & M D
757 LAKSONEN LOOP
SPRINGFIELD OR 97478
ELECTRICAL CONTRACTOR:
PRECISION ELECTRICAL GROUP INC 541-729-6570
4257 BARGER DR #125
EUGENE OR 97402
CCB # 145436 Expiration Date: 04/0112003
Desc riotion Amount Paid. Date Paid Receiot Num her Cashier
+ 7% State Surcharge 4.62 10/14/2002 2200200000000000061 dim
+ 8% Administrative Fee 5.28 10/14/2002 2200200000000000061 dim
Add, Alter, Extend Cire Ea Add 3.00 10/14/2002 2200200000000000061 dim
Perm Serv/Fdr 200 amps or less 63.00 10/1412002 2200200000000000061 dim
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 Insoections:
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service.
3 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 ofthe 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 thai all required inspections are requested at the proper time, tha~each address is readable from the
;: an(? t:e :PC:Zl plans, if applicable, will remain on the site ::';I~~~n':::truction.
Owner or Contrlictors Signature Date I I
I of I