HomeMy WebLinkAboutPermit Electrical 2003-3-12
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roject as submitted has the following
I I , oes not require specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (~. 689 "
ELECTRlCALPERMITAPPLICATION /c Zoning l'/)r2..:'
City Job Number (:;c...(;f' z.co3-co/~~ Date oy/Z, 0:3 Date ~ - I;l" - D") )
1. I LOCATION OFINSTALLATlON
20 (; z.. LoVV'-o--.. c:l Av~
A. I New Residential- Single or Multi-Family per dwelling"" ~
Service Included
New Alteration or Extension Per Panel
One Circuit / $ ~
Each Additional Circuit or with <: ,,",t. ~ _..0;'\
~ Y-.~ . Service or Feeder Pennit :1-?W~ \\ ('\ ~.>..""
Owners Name 0...,. '\~ PI.(L~v'~ ~,- \t~'.=-~~~\..\.~"~~p,,,"t.W' -~\\-, ~-'-~l
Address ;20(., 7.-. LoM.oNO.,,\~'Pk~~\\~f...\' E. r l\\~~~p-~e ~d'e'r' ~f-Each Instanation
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City ~: ~~ \~ P.J!on'e~ ,\,\~<I{)i ....~O":t,')C\ 'O'i Pump ~ICt.\l Q~\\\Q\l' $ 50.00
\, \ u\".u\e~eO '(>j ~e ~1)\"O\>o~ "'~I)\0S Sign/O'tIiJlll\i!i i~'{ ? $ 50,00
OWNERINST~CLA!:ION~I.~"~,,~ol)~" o\\"e R"o~~ ~ Limited~'llJ esidential $25.00
,..' N~I)\" ('e~'1 r\'\C\'i! "c:,\eS \e\e, '(j'l>\\O .. .
The installation:is being,niade O'n'p.rop,ef!y'J own\>whicll"~ LImIted Energy/Commercial $ 45.00
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IS not mtende8\.(oi,salgcIease or<rent.l ~~ ..:::l.\\\'" 1l.1l.'\- Minimum Electric Permit Inspection Fee~, Surcharges
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Owners Signlli '~"^ "!.."e ''r>eO~ ~C\\Y'1i 4.1 SUBTOTALOFAl30VE I
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LEGAL DESCRIPTION
i7()'\'Z"S'17
0/3'00
JOB DESCRIPTION
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L'I,JL b
Permits are non-transferable and expire if work is
not started within J 80 days of issuance or if work is
Suspended for 180 days.
2. I CONTRACTORINSTALLATlONONLY I
Electrical Contractor \
Address
I \-
/'-
City
Expiration Date
Signature of Supervising Electrician
Inspection Request: 726-3769
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:
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
c. I TemporaryServices or Feeders
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
Over 600 Amps or 1000 Volts see "B" above.
D. I Branch Circuits
$ 50.00
$ 69,00
$100.00
Lf3
7% State Surcharge
10% Administrative Fee
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Sir
Lf.>G
$'-;;2 r;:r
TOTAL
Shared Drive(T:)/Building Fonns/ElectricaJ Pennit 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:
ELE2003-00068
3112/2003
3/12/2003
9/12/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
2062 LOMOND AVE
1703251201800
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Residential
PROJECT DESCRIPTION: 1 circuit for hot tub
OWNER! APPLICANT:
MARK BARR
2062 LOMOND AVE
SPRINGFIELD OR 97477
541-747-4013
ELECTRICAL CONTRACfOR:
MARK BARR
2062 LOMOND AVE
SPRINGFIELD OR 97477
CCB # Expiration Date:
Descrintion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fce
+ 7% State Surcharge
Add. Alter. Extend Circ
Minimum/Adiustment Electrical
4,50
3.15
43,00
2.00
03/12/2003
03/1212003
03/1212003
03/1212003
1200200000000000811
1200200000000000811
1200200000000000811
1200200000000000811
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 the following working day,
Reouired I nsnections:
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete,
By Signature, 1 state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I fu~her certifY that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfiflll\~~[I, the laws of the State of Oregon pertaining to the work described herein. I
further certifY that only contractors(an-d'i?mpffi~ees~Who are in compliance with ORS 701.055 will be used on this project I
further agree to ensure that al!,r"eq'il;}~dl~I!",Ctl~;;':;tie requested at the proper time, that each address is re~rom the
street, and that the approved~s\~ 4!f.'pl~n~/lf'ilppl'i'C;;h!e~'\vill remain on the site at all times during constt:~. ~\.),
^",':J\e~eO '(j o"e \~; O'?-~~e \~W ~e Sl\~'t. ~ ~\, \~
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Owner or C~~trncto,'tSi~IJP~~~\~ '", '~o~\~~X\e \e'~~\~\C;<>' ~~c!."\oo~WI\' ':l~~~'t.~ \ {I~~\.)\.)~t."
\o\~o~'lJ.'i.\o~'/.:\}\}V 0'(j\'lJ.\(\ ~0\e0'i.~\',,'l~o,r:.l' ,'I\\S \>~\\\1.'t.\) \) \.)~ \S ~'O
_\o\~~...<(-.'!J~ ~'lJ.'l (\\e~' ,,0(\ 'J:>'/.:"/:; ~~\\"\ c.'I;\~'t.\) oc.<j,\\.)\)'
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I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00068
ELE2003-00068
ELE2003-00068
ELE2003-00068
Payments:
Type of Payment
Check
Paid By
MARK BARR
Description
Add, Alter, Extend Circ
Receipt #: 1200200000000000811
Date: 03/12/2003
Minimum! Adjustment Electrical
+ 10% Administrative Fee
+ 7% Slate Surcharge
Received By
Check N umber Confirm No
djb
Page 1 of I
3/12/2003
rr
11 :26:39AM
City of Springfieldr,
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:
cRcccipt.rpt