HomeMy WebLinkAboutPermit Electrical 2003-6-2
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:" ',~' .' CiTY OF S'.JINGFIELD, OREGON 0
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2i5.FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72.6-.;lM'lubf<"\\:?eciliC lall
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ELECTRICAL PERMIT APPLICATION "ineloIIO",in: dOeS nO\' ~ .
City Job Number EU~Z003-0013S Date ~ t?-n2_~~~;n ,,,,;,0
tl~' ZOf\\1\g ~ ~ ~
I. . LOCATION OF INSTALLATION 3. COMPLETE FEE SCHE ~~
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LEGAL DESCRIPTION A. New Residentiti - Single or Multi-Family per dwelling uuit.
/7D32200 028"00 Service Included
JOB DESCRIPTION
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1
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
2.
CONrRACTOR INSTALLATION ONLY
Electrical Contractor L (/ r/' ,E-;~r1j1--j<:!-
Address 3"~5 .1J c)'4-vpi//rcJ .];K...
City Th YeJU a
Phone $'~/-~.!j~-I.=?5;;<.
Supervisor License Number ~7..;-'~ .s-
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufacfd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B. ~ 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. t_~~~~~p~~!r~_ ~er~~~:~_~l: Fe~ders
Expiration Date ';.' 7- .0;:;.. "S- /0/ q~&C20 r Installation, Alteration or Relocation
.:..,0 c~ ....0<'::' " 200 Amps or less / $ 50.00 &:;0
. /.,t::;'L100 CV "" 'V ~ ,,<:;) -', .
Constr. Contr. Number I. j / / lo ~<::- ,lZl XV -0 20 I Amps to 400 Amps $ 69.00
/ .o'fi!;"',ro'0.-t;0 - * $-0""!;:-0 '\9' Amps to 600 Amps $100.00
ExpiratIOn Date - ::z 7 - ::?~~ S- r,>~ ::>:;-0 ~o .. ..
- ~ '.0' ~" .$'- U' !;..~. 0'>. .,v'liOver 600 ~mjls O! 1000 yoll' see B~bove. _ _
Signature of Supervising Electricianf -0"'" q," S$ 0 .....W o~D. Branch Cireuits~\\;)'{I. ",,\
~ 0 f';:S "" 0 ~ ;;X ._-- -. - - '1,' ~v -
~ )/ /" kro ",<::-G.s~ 0~0 .~.~ r:f New Alleration or ExtensiOlt~:~llel
" 0"', . c; ~0 .~ ri;l t. ":.K ~'<'
. I' _ ~ , .,' ,,<, ,0 ,~ n;v One Circuit ~ ~ ~ <,tV $ 43.00
. .S:-" . <b"" -OW' ..:"- ~I> ~ ~ r;S-' ~ Each Additional Circl't~r ~~~
#' K> ,~'" <;:)<:;).~2') <'-;:'..(..<b~~ ServiceorFeedert~~C:> ~<::> $ 3.00
Owners Name r<p{f~~ :~: e; -l/{i<7",' ---.. . x-.~(,~" ~~ -' ...
Address '3 26 7~~i;:!fyIMt!J f~.dr:Jfi-1 E. .!\~~"I~~f.i~:t~~~<S'~.de..': 1I0t illcl~ded) ~Ea<h Installation
~ 0 s;). 'S'''''~'' ro"" -I.'" ~"I-'(,~ \;),. ~v
City e::--U G-tNe.S' pno~~:()0 CJ 1Ji1nP~r ~Ula~ <:(<<; $ 50.00
-..) <::-~" "I(Slg~~tl~~~~g $ 50.00
OWNER INSTALLATION Linlj~\S~er~Residential $ 25.00
The installation is being made on property I own which Limit?ii~rgY/Commercia' $ 45.00
is not intended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
Inspection Request: 726-3769
4. SUBTOTAL OF ABOVE
.J(() -
3JC>
FOo
:f 58~
7% State Surcharge
10% Administrative Fee
TOTAL
Shan.>d Drivc(T:)/Building f'onns/Elcctrical Pennit Application 1-03.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:
ELE2003-00135
6/2/2003
6/2/2003
12/2/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
496 HARLOW RD
1703220002800
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION: Temp electric only
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o~ '[\'1
~~ \)~\ ~
~:l3 0<C- c'\O RJ....
.O~no; _ '" _ rJ ._,
>I' V' 'iYv",')v ~.
Descrintion ~ \'If. ..:s-c Amount Paid~ e
oR>O '0'1 ~\)' 0' '",c' O~ ~
+ 10% Administrative.Eeo' ~l" 0",0 ,if 5:00 ~e'V~ ~O
+ 7% State Surcha!]!",' Oo'V ~ ","<:' ..:s-~O '\c<,3':'50~ ~\\(j
Temp PowerJQO\~'11?~or<.less~....() (jO'V J.I');Qo..\~O ~.
Av .,,'\: ("".0 N ".('\ -.'\ .,,''''_l\,YI
\('-.' *' ~-~' n""v \~- 'V.... I~J ~
To Reque.st:(n. in1ii>~tioflicall%e",64.hol!f~res:ofding at 726-3769. All inspections requested befor..~.~. will be made the same
working d~{f:in~~eft~!J';r~~St'eiUft~~7J06' a.m. will be made the following working day.1i' ..,;x\'t. \':l ~\)
~ O~_ -1.0 _.;s.0 ,,~0 . rS .,,\<;l,~ '\."...l\\\~a.
\' RJ':lv ~\\ "" \u' [\C'. \.. 'if.. y{.' \) ~ -
Reouired lrisDe~t!onn~:rp C~. ~ ':l'(,~\~ \'(,\\\)\)~~
1 Temporary EI~ctric: Approval required prior to U~~~vyt.-i~~~~~ff.!'~lQ~
v,\S a.\1.~ ('\~~'~.
By Signature, I state and agree, that I have carefully exam1tieil~!\~cO ,ij . ation and do hereby certify that all
information hereon is true and correct, and I further certif~Hat.,!p~~ ork performed shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the si~~ot:,'<>>egon pertaining to the work described herein. I further
certify that only contractors and employees who are in compliip~ 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/APPLICANT:
BULLOCK PROPERTIES LLC
32671 SKYHAWK WAY
EUGENE OR 97405
ELECTRICAL CONTRACTOR:
KIDD ELECTRIC
35657 SHOREVIEW DRIVE
DORENA OR 97434
CCB # 154009 Expiration Date: 01/2712005
541-942-1352
Date Paid
Receint Number
06/02/2003
06/02/2003
06/02/2003
1200200000000001393
1200200000000001393
1200200000000001393
Owner or Contractors Signature
Date
Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department ...
Public Works Department
Official Receipt ..
Receipt #: 1200200000000001393
Date: 06/02/2003
ELE2003-00 135
ELE2003-00 135
ELE2003-00 135
Description
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Powcr 200 amps or Icss
Amount Paid
Job/Journal Number
Item Total:
5.00
3.50
50.00
$58.50
Payments:
Type of Payment
Chcck
I'aid By
KlDD ELECTRIC
N.eceived My
djb
Check Number Conllrm No
How Received
In Person
Payment Total:
Amount Paid
58.50
$58.50
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6/2/2003
1O:43:06AM
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