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HomeMy WebLinkAboutPermit Electrical 2003-7-16 -, , CITY OF ~ \lNG~IELD, OREGON;,.:, ( )..,..", . I." II: , submitted has the following eqUlre speciilc land use 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F~.o(MI)726-3689 ' , ELECTRICAL PERMIT APPLICATION Zoning k'"j;)rc::- . City Job Number Eu::;lo03-[Dlto7 Date 7-1,:)~ Date '7- '<..-o~ q{,J I', 'I ' I " "."'ortzea~""L,c I.LOc;ATION gF INS1'.ALLAJ10iV.i 3. COMPLE~EFl}E SPHEDULEI?ELUW, , , ~1q () ,1Jo :;cb-/J) r,.fJ/'r .-I.c4-1l, LE\GN^D,t~~()(IPT~Nm()f\'A. ,/'- A,I Now ~esi~~nti'H ".'Singleor Multi-Familj;per'dwelljng I!nit. 'I , II Y 1.AL1 J W0 Service Included JOB DESCRIPTION~..1.-Ge..> ~ pe~m' s are non-trani~ and:~~ ;~rk is not started within 180 days of issuance or if work is Suspended for 180 days, , /7' New Alteration or Extension Per Panel t'. . -- A./ One Circuit $ 43,00 o~m Name I/le I ~p/n :/ffr~ ~:~~::~~~~~~~~~~~~~i~;l~~~~ Address ~7 90 ih ./~u) Ljj. E. ~~c0Fl~~.~~.re'rlr~.Ea,~h},;istanationl W' , ~JIj. . MV,1RO DA.Y PERIUU. City c::A:. PhonQ'fJ- ?t/7-7tJ/-2. 'Pu~'Ofirrl!;'lItlOn $50.00 Sign/Outline Lighting $ 50,00 Limited Energy/Residential $ 25,00 Limited Energy/Commercial $ 45,00 2. I C(JNTRAg'ORiN,STALLATION ONL't1 Electrical contractoftJ: 1/ ;/Jhf & r ./YIr ~ Adtb-ess ~GI ~H ...:2 /_"'itfJ...3 , , City . 1.1 (9t /lfj _ Phone$'1I-i1% ;;2365 Supervisor License Number 3-2 J? d S Expiration Date / () -0 1-0 q Constr, Contr, Number ,5 I O,?,.p Expiration Date la -::+7-05 , OVVNERINSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 ~~'~~~~ 1000 sq, ft, or less Each additional 500 sq, ft, or portion thereof $ 106,00 $ 19,00 Each Manufac!' d Home or Modular Dwelling Service or Feeder $50,00 B.I Ser\'ie,eso;'F~~~rs'''':lns,lali~ti;'il; .Ait~<<a:tiop~o~ Relocation: ' I 200 Amps or less . 6,,"I,,uU~l&,Il!ju,t,>(. 3 _ 0 0 _.:r'nN'uregol.. ",lItll'trY 201 Amp'jl.lVll!\l'l<lIlJ'S" ted t,"hAorl$~:"lY 1 " 401 Am~lnp\adop Tr..,'''''' rule~iJI~~,ffi9t :::;.' _.."n Center. t"\AR Q<;2"vv 601 AnurotPltt"""~P.h1..()()10!hrOUQh"~T63:00 l-~ h Over 1~01l1!l\AA;fiS"Uy obtain copies c$3'tf.0~o:':' Reconn~'r'ou ma center. {Note: tn~t~~ ~.)_n ~1I\ng the; ~ '')7'0 I.Jtilit't Notl IC~. - c. I Tempor~r~Mlr~~dt:!Md~~Z,2a'~I', ' . H 1 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 1000 Volts see "B" above, D, I ;8i'a'ricil,Cifiafifi}i:\~t~,>~: ", _,__ "._ ", ",c""""_<>,_..;r,d,'",,, . , "I .^ Minimum Electric Permit Inspection Fee is $45,00 + Surcharges 4. ~SJJ1il:O~Af;Or;;wi?':E;': /".~_ 00 tf(jl _0.-'>n '1.-3.1/ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application l-Q3.doc ., Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: ASSESSOR'S PARCEL NO,: PROJECT DESCRIPTION: OWNER/APPLICANT: DELORES O'BRIAN 3790 HAYDEN BRIDGE RD SPRINGFIELD OR 97477 Descrintion + 10% Administrative Fee + 7% State Surcharge Penn ServlFdr 200 amps or less . - City of Springfield Electrical Permit Attachment PERMIT NO,: ISSUED: APPLIED: EXPIRES: ELE2003-00167 7/15/2003 7/15/2003 1/15/2004 3790 Hayden Bridge RD 1702190000203 Springfield TYPE OF WORK, New .TYPE OF 1 J~F' !8nmmercial T'T'ENTION:UregoolaWreqUIftI '-1-, ' Pi. I I d by the Oregon Utility f"Unw rUle8 adopte I . ; __~ Ml Inri I\IDI!~ER~:cdNJ".RAGT<iR:952'{)O i%~~~~~i9r1~ipieS of the r511P-%~.2365 ~B~~503' ,,"'-'. r. (Note: the telepho~e EUGEM!l0~97~'0211 "" lJII'Ii1Y{\~R~licatlon C~1h~e~~~rthEa<Pmalon hi. Ii, ~211'2005 :k,t.:~::. Qn"_"',,,?-2 . Date Paid Receiut Numher Change out service for SUB 541-747-7012 Amount Paid 6,30 4.41 63,00 07115/2003 07115/2003 07115/2003 1200200000000001758 1200200000000001758 1200200000000001758 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 Insoections: E' 1\11: WORK 1 Electric Service, Approval required prior to utility company e~lM~~~'NIiPf'S\1p..LL [)(.PIRI: ~~Mll IS N01 1\1IS ill I IMr\ER 1\1IS Pc-['\ r" By Signature, I state and agree, that I have carefully examined the c'lI"~f~\jippllc~tiijit ~nd~ol~!',~ro:EhfiW'that all information hereon is true and correct, and I further certify that any ~;nd~aq~w~1i pe'r.ffir~e~ siiall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of'0\!M6r,oPfrt~!!iiiig'j'Jlthlwork described herein. I further certify that only contractors and employees who are in compliance wifh~ORS"7'01.055 will be used on this project. I further agree to ensure all re , ired inspecti s are requested at the proper time, that each addr 1s is readable from the street, and that the ap' ov setf/~Ians, ';:'Z: w:: on the site at all times dUring: tru~~f&~ Ow~ or Contractors Signature / Blire / /;; Page I of I 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number ELE2003-00 167 ELE2003-00 167 ELE2003-00 167 Payments: Type or Payment CreditCard ~-~"''''''"'''~'''''''''''<~--'''"',,:. ", \ i ._'~ ' ~"'-... ) ',,,,w.o.- ~; "...,,.,.~. . ,'- Receipt #: 1200200000000001758 Description Perm ServlFdr 200 amps or less + 10% Administrative Fee + 7% State Surcharge Received By ddk Check Number Batch Number Authorization Number Paid By NEW WAY ELECTRIC 000120 060107 City of Springfield Official ReceiJl)t Development Services Department Public Works Department Date: 07/15/2003 8:S3:27AM Amount Paid Item Total: 63,00 6.30 4.41' $73.71 How Received In Person Payment Total: Amount Paid $73,71 $73.71 . .