HomeMy WebLinkAboutPermit Electrical 2003-6-9
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- 4~ , , . CITY OF ~-,hNGFIELi:>, ORJ;:GON ( "
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lhe following
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (5n411~~(j~Dllgubmitledhafs land use
,.he tollo'iJ11g-p C7l ire specl Ie
ELECTRICAL PERMIT APPLICATION zoning. and does nol requ H?.
City Job Number BB::::).IY:?, -OOly.ooa.e '1 .\llI"lJ2-,.9P~~;;g,_ " 3-0'3
3. 'COMPLETi00i6E ~f:h~m.JL.: J~LOHFK~
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4. i~~CJ~~OT~_O~~?-V~~-- - ___$60 .oV
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~ '\~~~1 c6. 0;: , ,Shared Drivc(T)lBuilding Fonns/Electric.1 Permit Applicotion H)J,doc
I. LOCATION OFINS~~:gO
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LEGAL DESCRIPTION 11 031.7.'2.
3o~ ~ G4--k...J ~;
JOB DESCRIPTION ..\ I
. ).. Hr'\f\ M I'-t. 2:eJlU t(T ~
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for t80 days.
2 CONTRACTOR INSTALLATION ONLY
. Ar'~HtJl".Vf~"aW{equlf"'sYOUtQ' ,
Ei&!6-!C;{I,~~~fuJi\r!rrPt~1'~i.?;te(~ ~
NoilflC3tlon Center. I nose l;)i~ are sel TOn'
\\1ddl-~s~ 952-00,P9r(!)l !ht/b'iti"-f)J.21C1t:{tfJo'
0090. You I lid}' UUld.1I1 ~UtJl~~ Ullllt:1IUI~o) u~
, cal!!LJ4.lt~X~I~ (Note: the+.Jl!f~o'Cn c:J)-
C1lY.U -,-__":__...I~~ -____nPi~one,.",--:.c:..-.........
I, I............ ...... ....... ...........~..... .....UIIl... w................_....... .
Center j~ l-Af1f1-332-2344).
Supervisor License Number 3,("C,-5
10;;<110 '-f
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Constf. Contr, Number 2d-2....qq c..
Expiration Date I 0 / f1 /0 4
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N..~ L - b -
Address ~~(),
City ~O'A\CU\li pt. Phone
OWNER INST ALLA TION
Expiration Date
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Ownen; Signature:
Inspection Request:
~\
. .-. - --- -p.~~onze-d signature
A. New Residential- Single or I\'lulti-Family per dwelling unit.
Service Included
1000 sq, ft. or less
Each additional 500 sq, ft, or
portion thereof
Each ManuracCd Home or
Modular Dwelling Service or
F eede,
$106,00
$ 19.00
$50,00
B. ' Services ~r Feede.~':.::'lnstallation, Alterations or Reiocation:
200 A~QlJI~~: '. , $ 63.00
201 Arrfi!l~cf'4Dcrf$.fl/PSH $ 75.00
401 A1J~n!DfOcii!}1f/JN~LL EXPIRF II: :.I.'!'{t?;OO
601 }nYp~M/jOQit~Ili'i f~R THIS PEFlMI7$1~~~8K
ove/V~d'oIA'\{?p!iWpl;ERfO ABANDOyr:f} F~~:z.5,&l
Reconnect Only 0, $150,00
I
c. , T.!.~I!,,,!a':Y.~~rvic.!s or F,eeders,_____ '
Installation, Alteration or Relocation
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 I 000 Volts see "B" above,
D. ; Br~~ch-ci~~~its _______u__ -- -----.--~.---------f
..... ---.-;
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuil or widl
Service or Feeder Pennit
$ 43,00
$ 3,00
,.-- --_......_.__._._._-~_._- ---.-.- --..---.-;.-
E. i Miscellaneous (Service/feeder not included) -Each Installation,
L__.___ ..._ _.._____ __ _ _. _._____ _.._ .._ ___
Pump or irrigation
Sign/Outline Lighling
Limhed Energy/Residential
Limi.ed Energy/Commercial
$ 50,00
$ 50,00
$ 25,00
$ 45,00
7% S.a.e Surcharge
10% Administralive Fee
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
54 I -726-3676 Fax
541-726-3769 Inspection line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00140
6/9/2003
6/9/2003
1219/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO,:
3033 GATEWAY ST APT 15
1703222003600
Springfield
ITPEOf'WORK:
lYPE OF USE:
Repair
Residential
PROJECT DESCRIPTION:
Reconnect
OWNERlAPPUcANT:
KKMH LLC
PO BOX 8099
PORTLAND OR 97207
ELECTRICAL CONTRACTOR:
GLEN A CAMPBELL 541-744-0705
PO BOX 264
WAL TERVILLE OR 97489
CCB # 73995 Expiration Date: OS/24/2004
Descriotion
Amount Paid
Date Paid
Receint Number
+ 10% Administrative Fee
+ 7% State Surcharge
Service Reconnect
5.00
3.50
50,00
06/09/2003
06/09/2003
06/09/2003
2200200000000001014
2200200000000001014
2200200000000001014
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 InsDections:
1 Electric Service: Approval required prior to utility company energizing service.
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 cnrrect, 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
1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
,
City of Springfield
Development Services DepartmeQt ~
Public Works DepartmeGt
Official Receiptp' ...
Receipt #: 2200200000000001014
Date: 06/09/2003
Job/Journal Number
ELE2003-00 140
ELE2003-00 140
ELE2003-00 140
Description
Service Reconnect
+ 10% Administrative Fee
+ 7% State Surcharge
Amount Paid
Item Total:
50.00
5,00
3.50
$58.50
Payments:
Type of Payment
Check
Paid By
GLEN A. CAMPBELL
Received By
njm
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
3270
58,50
$58.50
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6/9/2003
2:24:24PM
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cReceipt.rpt