HomeMy WebLinkAboutPermit Electrical 2003-05-20Gity of Springfield
Electrical Permit Attachment
Status: missing from list
225 Fifth Street
Springfield, Oregon 97477
541-726-3159 Phone
541-726-3676Fax
541-7 26-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00132
5t20t2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
340 24THST
1703361409000
Springfield
TYPE OF WORK:
TYPE OF USE:
PROJECT DESCRIPTION: 200 amp service
OWNER/APPLICANT:
ANDERSONDAVIDW&MARIA
340 N 24TH ST
SPRINGFIELD OR97477
ELECTRICAL CONTRACTOR:
owNE[0Tlc E.
THIS PERMIT SHALL E)tPlHE iF IFri:\,,-i r,,
CCB # AUTHORIEOUNIISIR"TSIIS PERN,II I IS ivu I
Descrintion
+ 10% Administrative Fee
+ 7Yo State Surcharge
Perm Serv/Fdr 200 amps or less
Amount Paid
6.30
4.41
63.00
trUlV
Date P*i$/180 DAY PERIO
llVlE,lltrE.U Un I lffl:l,#N[Hf#i(u.-
05t2012003
05t20/2003
0s120/2003
2200200000000000888
2200200000000000888
2200200000000000888
To Request an inspection call the 24 hour recording at726-3769. 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.
Required Inspections:
1 Eleckic 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 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
approved set will remain on the site at all times
or Contractors Date
Paee I of I
lxEarltD
nco
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gon u
the telePhone
)-?344\
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FIFTIISTREET:
ELECTWCAL
City.Iob Nunrber 2
1, LOCAI'TON O}, TNST'ALI-/T7TAN
I-EGAL DESCRIPTION
SPRINGFIELD,OR97477 o plt:(54 1)726-3753 r FAX: (54 1)726_365s Wo,6
3. COMT'LE'IE *EE SCHEDLTLE BELOI4/
I
c
.IOB DES
rl €(A Sc.rtt t(l
Permits are non-transferable and expire if n,ork is
not started within 180 days of issuance or if work is
Suspended for 180 days.
Service Included
1000 sq. ft. or less
Each additional 500 sc1. 11. or
portion thereof
Each Manufact'd Home or
Jvrodular Dwelling Service or
Feeder $50.00
s 106.0t)
.$ r9.00
.00
CF
B. Services or Feerlers * Ilrslallati*n. Al{erati*ns
,/
200 Amps or less \/ $ 63Electrical
Address
Supervisor
Expiration
Constr-'Contr. Number
Expiration Date
Signafure of Supervising Electrician
2.OAIT-
Ciry
201 ArdpspiaQfiS#ptir,\.1 fl.pL-s l. r $ J5,ap
40r AdobJqq ffi ffupu irr ; p g i lqs+i*-ru i$l
zs'oo
*ffiffi.*AXtr'rl-frr@f;fi3},
Reconnect Only $ 50.00
C.
Installation, Alteration or Relocation
$ s0.00200 Amps or less
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
D. Branch Circuits
New Alteration or Extension Per Panel
Owners Name
One Circuit
l:rch Additional Circuit or with
Service or Feeder Permit $ 3'oo
E. l,'niseellaueous (Servicelfeeder trof included) -Each Instaliation
Pi^rmp or irrigation
s 43.00
s -s0.0c
$ s0.00
)qo Jqf t"Address
City
rr Flione
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Sign/Outline Lighting
Limited Energy/Residential $ 25-00
Limited Energy/Commercial $ 45'00
Minimrrm Electric Permit Inspection Fee is $45'00 * Surcharges
7'l/n State Surcharge
10% Administrative Fee
TOTAL
4. SL|BT'OTAT-OF',A,&OVE lri
Qso
Inspection Request: 726-3769
Shared Drive(T: )lBuildin-e Forrns/Electtical Pennit Appl ication I -03.doc
I New llesidential - Single or plulti-Fanrih,per rtwetting unit.
INS'{ALTAruON
pted by the oregon
or Reloc:rtion;
\5'.)l-0010 throuoh (
1-.{ a i
9s2-00
*!{1 n e
telePhone
Notification
o-332-2344)
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