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HomeMy WebLinkAboutPermit Electrical 2003-2-20 ;, " -, 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 I. LOCAnl{fgF~iAC!JI8d3 ~/5'.q k/jJ]1f.' ~~ (')~r CflV7f1 1 LEGAL DESCRIPTION I '1. tJ '3 ' -;(~. 1.J' Dd'f()l) Service I~~_I~~~~"" __"''''og ,~~ ,.,1.- 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 \ -( \ 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 ,. ',- . . 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