HomeMy WebLinkAboutPermit Electrical 2003-2-20
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" -, CITY OF. t.JJNGFIELD, OREGON 0,'
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ~'J 58 lDe)1 Date:J-,,;1t)-O '5
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LEGAL DESCRIPTION
I '1. tJ '3 ' -;(~. 1.J' Dd'f()l) Service I~~_I~~~~"" __"''''og
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JOB DESCRIPTION 1'hi tollOWlnr, "'0""1000 'gJe.pcless ,"". u,'.
tIP ry- ~onlnQ .n" vv-. 'fadhadditi~~q, fe or
_('J/7C/L./( 77!J1 'T ~PIOVb' _ port~E.!h~_----'-
,/,-. , " - Lorl<np-, 'J-O~
Prrmits are non-transferable and expire 'ifJwork i~ . ~.~iJfact-'d'H6ifl--or-
not started within 180 days of issuanCf\JJPi(~~~~'st"craoPl;(~~d~':Y!!....~\' ;-:0 Sf $5000
Suspended for 180 days, otlflcatA\lt'i\J;:('lTt~i.","F;ee-der ' , '
InOARg ~ 'U",
5~"OOl-001(J' - . ' , ,
2, CONTRACTOR INSTALLAlIJ(')N.QiYlt?nay b B. IhServices or Feeders -Installation, Alterations or Relocation:
cal/in 0 lam CQF-lIt'
gthecenler (Pi" ,,: . "0<, 'U"'~,
nU"'bArf~. tne Or~ ~o~r~,~~!l ?ii!/;'i3hone
Cenlerl 1 9 20IJArDP.Srt6.:..4qo,,~p.s
S -BOr. n.,.., . . .., wUtm
>!OI'AmpS',tbJ~PO Amps
60 I Amps 10 1000 Amps
!lOT~~. Over 1000 AmpslVolts
I N/:> PERMIT SHALL EXPIRE I Reconnect Only
AUTHORIZED UNDER THIS PE F THE WORK ,
Supervisor L.cense Nunlt1JMMENCFfJ n~ 'S ^ B ^ p RM([ ISrrdQJilorary Semces or Feeders
ANY 180 DAY PERIOD' ,,100NED FOR, , ,
ExpiratIon Date . InstallatIOn, Alteration or Relocation
Electrical Contractor
Address
City
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
/ ~ ~-;;L
. Owners Name fL~I'?VI/l/A.C; "L;-vC~ f(
Address~ / -) ~ L ()c!-l D~
City . ~ cx{:j Phone 7;<r; O~:(O
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\ OWNER INSTALLATION
The installation is being made on property lawn which
is not intended for sale, lease or rent.
X~~_{;;{~
/ ty V(
, Inspection Request: 726-3769
3,
COMPLETE ,FEE SCHEDULE BELOW
A. New Residential - Single or J\1ulti-Family per dwelling unit.
$106,00
$ 19,00
$ 63,00
$ 75,00
$125,00
$163,00
$375,00
$ 50,00
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50,00
$ 69,00
$100,00
Over 600 Amps or 1000 Volts see "B" above,
D, Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
$43,00 ',)
$ 3,00
E, Miscellaneous (Sen'ice/feeder not included) -Eaeh Installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50,00
$ 50,00
$ 25,00
$ 45,00
Minimum Electric Permit Inspection Fee is $45,00 + Surcharges
4. SUBTOTAL OF ABOVE
~< -
-
3,1~
Lf.ru
0;l.,. ee.s;--
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Dnvc(T:)/Building Fonns/Electrical Pcnnit Application I-03.doc
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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:
ELE2003-00053
2/20/2003
2/20/2003
8/20/2003
SITE ADDRESS: 2158 LOCH DR
ASSESSOR'S PARCEL NO,: 1703251202400
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Residential
PROJECT DESCRIPTION: Electrical circuit for hot tub
OWNER! APPLICANT: ELECTRICAL CONTRACfOR:
FICEK THOMAS J & KA THLEENI
2158 LOCH DR
SPRINGFIELD OR 97477
CCB #
, Expiration Date:
Descriotion Amount Paid Date Paid Receiot Number
+ 10% Administrative Fee 4,50 02/20/2003 1200200000000000731
+ 7% State Surcharge 3,15 02/20/2003 1200200000000000731
Add. Alter, Extend Circ 43,00 02/20/2003 1200200000000000731
Minimum! Adjustment Electrical 2,00 02/20/2003 1200200000000000731
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 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 hereilL 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
~~~~:~ed ?~i11 remain on ;site;;;1 ~ddU:; ;ns:;:g'
7t:rorC~;;SignatuTe/ / Lriate
I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00053
ELE2003-00053
ELE2003-00053
ELE2003-00053
Payments:
T}IIe of Payment
Cash
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 1200200000000000731
Date: 02/20/2003
Minimum/Adjustment Electrical
+ 10% Administrative Fee
+ 7% State Surcharge
THOMAS FICEK
Received By
Check Number Confirm No
Ikw
Page I ofl
'\,
2/20/2003
2:29:12PM /'
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
43,00
2,00
4.50
3,15
Line Item Total:
$52.65
How Received
Amount Paid
In Person
52,65
$52.65
.
Payment Total:
cReceipt.rpt