HomeMy WebLinkAboutPermit Electrical 2002-12-18City of Springfietd
E lectri cal P erm it Attachme nt
Status: Issued
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
541-726-3676Fax
541-7 26-3769 Inspection Line
PERMITNO.:
ISSUED:
APPLIED:
EXPIRES:
ELE,2002-00166
12n8t2002
12n8t2002
6n8t2003
SITE ADDRESS:
ASSESSOR'S PARCELNO.:
PROJECT DESCRIPTION:
888 S 28th St
1803010000201 TYPE
Springfield
OF WORK:
TYPE OF USE
New
Commercial
Install temp power for water testing equipment only
OWNERYAPPLICANT:
SPRINGFIELD UTILITY BOARD
223 AST
SPRINGFIELD OP.97477
ELECTRICAL NTRACTOR:
OLSSON INDUSTRIAL ELECTRIC 541-]41-8460
PO BOX 70413
EUGENE OR 97401
CCB # 63473 Expiration Date: 0l/2612005
Description
+ 7o/o State Surcharge
+ 8% Administrative Fee
Temp Power 201 - 400 amPs
Amount Paid
4.83
5.52
69.00
Date Paid
1211812002
t211812002
tzl18/2002
Receipt Number
1200200000000000430
1200200000000000430
1200200000000000430
To Request an inspection call the Z4hour recording ar726'3769.
inspections requested after 7:00 a.m. will be made the following
All inspections
working day
7:00 a"m. will be made the same working day,
15
Required Insnections:
1 Temporary Electric: Approval required prior pole.
By Signatu re, I state and agree, that I completed application and do hereby certify that all
information hereon is true and co any and all work performed shall be done in accordance
with the Ordinances of the CitY of ofthe State of Oregon pertaining to the work described herein I
further certify that only contractors a are in compliance with ORS 701.055 will be used on this project I
further agree to ensure that all required are requested at the proper time, that each address is readable from the
street, and that the approved set ofplans'will remain on the site at all times during construction.
Owner or Contractors Sigtature Date
1of1
fx'd'#'riflsh-J*
s1477
12,/lbz<v
1:41:22PM
D everopm"", r.i,'[.1tf.119, ",o'
P ub li c *'
Hiu'.,'"\ H:HI
Receipt #z 1200200000000000430
Date: t211812002
Line
PaYments:
al Number
ELE2oo2-00t66
ELEzooz-O0166
ELEzooz-)}r66
Temp Power 201 - 400 amPs
+ 8% Administrative Fee
+ loh State Surcharge
Line Item Total:
How Received
In Person
P Total:
Amount
$7935
Amount Paid
79.35
$7e .J5
TYPe ofPaYment Paid BY
OLSSON INDUSTRIAL
ELECTRIC
Received By CheckNumber Confirm No
djb
Check
Page I of I
cReceipr.rpt
69.00
s.52
4.83
t
W;
1FFICE: 726-i7ts
1. LOCATION OF INSTALLATION
888 S.28th Street
LEGAL DESCRIPTION
i *t;S c>tt> e, c, ctzu,
JOB DESCRIPTION
2. CONTRACTOR
Electical Contractor_E1ectr:!-ql_Igc.
Signafiue of Supervising Electrician
OwnerS Name S.U.L
ELECTRTCAL PERMIT APPLI CATION
Arylob ece z:c,oZ _ 6 o ra€
3. COMPLETE FEE SC}IEDLILE BELOS/
A. New Residential-single or
Multi-Family per dwelling unit.
\rte
Items Cost Sum
sq
$ 19.00
Home or
Dwelling
Senrice or Feeder
B. Services or Feeders
Installation, Alterations or
Relocation:
200 amps $ 63.00
$ 7s.00
$125.00
$163.00
$37s.00
$ s0.00
201
$s0.00-T- $6e.oo -6il0o
Over 401 to 600 amps
Over 600 amps or 1000 volts see
"Bt'abovg
Address
trb
OWNER INSTALLATION
The installation is being made on
properly I own which is not intended
for sale, lease or rent.
D. Branch Circuits
New, Alteration or Extension Per Panel
One Circuit $43.00
Each Additional Circuit or with Service
or Feeder Permit $ 3.00
69.OO
E. Miscellaneous (Sewice/feeder not included)
-Each installation
Pump or irrigation $50'00
Sign/Outline Lighting- $50'00
Limited EnergYiRes $2s'oo
LimitedEnergY/Comm $45'00
zz7 A
5. SI]BTOTAL OF ABOVE
7% State Surcharge
B% Administrative Fee
$100.00
4-e3
5.52
79.35
Owners Signature:
TOTAL
Olsson
Address 1919 Laura Street
City_Eprinef ield- Phone--.( 54l)14fo$46O
$ s0.00
Supervisor
Expiration
License Number 3334S
10-1-O4
amps
OnIy
Services or Feeders
Installatioq Alteration or Relocation
I
Constr Conft.63473
E:<piration r-2ffi5