HomeMy WebLinkAboutPermit Electrical 2003-7-16
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, CITY OF ~ \lNG~IELD, OREGON;,.:, ( )..,..",
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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~
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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~,>~:
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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
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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
.
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