HomeMy WebLinkAboutPermit Electrical 2002-12-2
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/1" , 22).F,IFTHpTREET , ' ;!. ,'\ .. '1.'
r f'~", \ !<SPRINGFIELD, OREGON97477"~ .
i\ "<:: I :INSPECTlqN ~QUpST: 72G=~76~-;'
'~.' 'I. OFFICE: 726-3759; ,I.,! n:S~6 J ,
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-","V'~ :"', ELE.CA.LPERl\1ITAPPLICATION
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:C:=i (C9rL~TE 1ES~HER~E BELO\V.: '~.. . . ';'. . ".
~~; 'N~w R~~~~:;!~~~~~I~~~~'~:re~lin;; U~it. ~~.- .'. '.. .;.
Scn'ice Included: h, ~ -, .:.
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Items Cost SUm'
LEGAL DESCRIPT!pN \
C!) Ol'loO ( e:r-c "
.... -" . d has the following .
JOB DESCiTION _ The to;:;ng p~cla1':~~i~~tt:peCi1iC WOOl!Rj'fL Dr less
Si.Vc. Clrtu... Hon' _ d d rfjY:~J 17 () Each addl110nal 500
I' approval t l cq ft e. ...anion
Permits are non-transferable and expiW'ing - ..... (jtt.~o thereof-
if work is n6t'started within b8Q, days _"'" '" E;;;;h ManuI'd Home or
of issuance hrifwork is suspel~d~d for S' nature _ [,TooUlar Dwelling (';
180 days. '.' 1\UI110nZad Ig Service or Feeder
$106.00
$ 19.00 ; "
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$ 50.00
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2. CON~CTOR \N~T ALLA TION ONLY B. Scn'iccs or Feedcrs '
\ 1 r'1 J... Installation, Altcraiionsor. \.
Electrical'Contiacto;L%h c:.le~lc... Relocation: /..........,.:... ..' ". "',
" ,., /' ArfEN \lU~uret;\o'..e:, ~{ ';..,'.'
Address {tj /':3 Ii' 'E ~ I>~""". 20\\:i1l1JPS on~ess.ad9pted ~y'~~~:'i~,~ $.6.~od~
C,'h.' (" b. 9, \/,i'p\110ne7/7. 1/ /..._....rv.............'......~.:,,'....._.............!-.....:.'''- 2.Q.b!\\Wl~!p~1PQ,ampst. Tho~ 'U1-'~"'$,h~O~ .
"-J, Ll ~ L40...... " 419!G\I1~~'9~0(l'1J91Rs11OfhrQt!gr,\)"'~.' $125.00 ~;
, , \ ' . . d' .6Bb~}9PS;l9J9ml:,al~i1~alntpptG~';,f".:'$16~06.~
Sup~rvisbrLicen~c'Nnmb~r 3l\ 9L.'........:.COvercM1a91,a,I\W8'':','I!.~le.r.. (N*; t;~" )8,,$375..00 ~.
/E.X'Pl' r.a.tl..10'...n',.....D.,...,.a...t.e....... -\.;....~...'....)...;...,"'.{....)....I......I...._.' '/......D.....,....'IL,................... .... ' . .' ...::..............._...:...:..'._.
:.:.'...,:....~.'..,.............. ..R~(BU\\1I1e9~ffr4ljgOfElg~ 1;Ullt " .'. $,;;0.00'--- '
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. .. .,' CTe,!IJlOrarv~crvicesorFceders . >:~." .
L.C~nst:c~ntr Nn~\~~/B4 {J:~9 t~Y::~;, 'Inst,illatio~, Al;~ratio,{drR~loc,i;ion .;; ,''1'/'>. . ";
:':'-~ExPiratl:~~~1/~rc5;J-l"')~1tC, " ::~ooamps orles!:Yt:~.- ".~.":'~if50.6!b .. .';
, '..~ I --.",,~'~; 20iarnpsto 400 amps:;;",';$69.00 ': ,:
'si~ri"iiurc of SUjlcrvising Electrician ---....,'--_Oy"!:.401t6606anlps:: ". . ..~ $)00.00 .
.. ..':/ ...""'':D.J NOTl~r; '60.oampsi)1:.L022,~02tssee, Ii
\..0.~""~ THIS PERMlT~.SHAll EXPIRE Ii:-THE;WOR~,' I.'
ow;;crs N:m~ h',y~J ".~ffLJN6-Rtt~~t~~;~~;~~~~~I~AA~N~T'
Address ZZ t"" S+IJ.:.'. 's 1- ANY b~R:e~ruftERIOp.; .
;jf" .'
Ea;h Additiona{ Circuit or with Service .
or Feeder P~rmit ..' ~j 3.00 z II
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. $43. 00
City
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Phone
OWNER INSTALLATION.
The installation is bei'!g made on'
property I o\rn which is not intended
for snle, lease or rent:
.. ' .
E. Misccllaneous (Senicclfeeder not included)
:-Each installation . \
. PUl11p'.orj'ri"igation' ~
Sign/Outliile Lighti!lg . .
Limited Energy/Res
Linlited Energy/Comm
$50.00
$50.00
$25.00
$45.00
. OWllcr.s Signatllrc:
. .
i\'linimum Electric Permit InsJlection Fcc is S45.00 + S\lrchargcs
4. SUBTOTAL OF ABOVE
7% State Surcharge
8% Adminisirativc Fcc
1)0
Jb so
1200
17l~
TOTAL
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City of Springfield
Electrical Permit Attachment
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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:
ELE2002-00147
12/2/2002
11/26/2002
6/212003
SITE ADDRESS: 0 Main St
ASSESSOR'S PARCEL NO.: 0000000000000
Springfield
TYPE OF WORK: New
TYPE OF USE: Public
PROJECT DESCRIPTION: Service and circuits for bridge lighting
OWNERlAPPUcANT:
CITY OF SPRINGFIELD
225 FIFTH STREET
SPRINGFIELD OR 97477
+ 7% State Surcharge
+ 8% Administrative Fee
Add, Alter. Extend Circ Ea Add
Perm ServlFdr 200 amps or less
10.50
12.00
24.00
i26.00
ELEGTRICAL CONTRACTOR:
AI 1"-""- . ,.--'''ymc - .
II LANJT,z,El!EGTRIC ". 541-726-0659
10. ~41~)\J~@JREET h02E . )_~ .
NOtll'SPRINGFIEW'0R(97478 .J-
in O/GGB'#"'84679'btailix.p.!r~i9n Date: 07/i4/2004
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v......-.. th ce1"'lter..\l\l,U~~' -' . . j .
Date Paidlhng e RocelOt Number "'~Cashier
b lor the VI<>g~,
12/0212002 er 2200200000000000249 ddk
12/0212002 Gel2200200000000000249 ddk
12/02/2002 2200200000000000249 ddk
12/02/2002 2200200000000000249 ddk
541-726-3753
Deserintion
Amount Paid
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: NOTICE: PIRE IF THE WORK
1 Rough Electric: Prior to Cover THIS PERMIT SHAl~ ~~IS PERMIT IS NOT
2 Electric Service: Approval required prior to utility compW;T~~&s\i~jrs ABANDONED FOR
3 Final Electric: When all electrical work is complete. COMME C OERIOD
ANY 180 DAY P .
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 of the 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 that all required inspections are requested at the proper time, that each address is readable from the
street, and that the approved set of plans, if applicable, will remain on the site at all times during construction.
Owner or Contractors Signature
Date
I of I