HomeMy WebLinkAboutPermit Electrical 2008-10-10
225 FIFTH STREET. SPRINGFIELD,OR97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRIC~ERMIT APPLICATION,
City Job Number )(" - en 11::I1
.-. - - ,
m[:T:~'~,~}m~,"__''''t''>':~'''''''Y'0'''''''''''''-'",,04'~"",:-1t'""'''''~''''..,,,,,,,,,...,.3&JiJi!!m!!"W!'lt":!'
1. fEOGA:fFIONiOEi1NST~ON: '''j , I'"
~~~;lO'44'PMV<'5",fhl1,,,,~p*~"""1>_-=0""t'"~40>''' m' I
t~Qq D3ISfTl~ (lJrld
JORDESCRIPTlON:
j- 7~(') ~ ~Wl
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1.-6i'fili1'WtWl,' iIilm,":Bwrwzw }!WfllAA: Y1'>>"."!'1I1%!'If,:?i! /t~ "'!ffi1ISn!1~r'iM&llJI1#@,rnM&"',iliRi!Jmmw~.QJ,
:,(3!ON!lJR;,tGTORi1NST~~1JlONiONbYJi
2. -~&F;~;liJiiID'Jti_0Jdit!h.ti:ttiiiHr*0b&iaOO~!'1:%;ii;wil0;JiG~;P~
Electrica] Contractor . / '
/
Ad~S
City ~
L
~
'~
Signature of Supervising Electrician
Owners NameJ'b illd LA)o ~J\n~
Address \ ~ ,~)3, 'i-
City\,Wrl
. Pbone
77Jog~2~
OWNER INSTALLATION
The installation is being made on property] own which
is no ed'for-s~] lease r rent.
Inspection Request: 726"3769
'Date
3. ~90.m>:t;;;b;J;-"SCHE.Df:.iil;)IBEWW:
:..m,,,._,",,,,,~,,,.,,,,,,,,,,,,,,,,,,~~,,E1"'P""""i'l'i#'i";';;"A>&i''''' ,,,,c' <M' , ,
A.'~i~ml;tfit'l~h~~l~mmrB.im!mlrmi~{!lli~
Service Included
1000 sq. ft. or less
Each additional 5.00 sq. ft. or
portion !hereof .
Each Manufact'd Home or
Modu]ar Dwelling Service or
Feeder
$]21.00
$ 22.00
$57.00
B.
200 Amps or less
20] Amps to 400 Amps '
40 I Amps to 600"'Amps
60 I Amps to ] 000 Amps
Over 1000 AmpsN oIts
Reconnect Only
$ 73.00
$ 86.00 .
$]43.00
$]86.00
$426.00
$ 57.00
c.
~JOTlCE', ' .
, l"Jnstallatlpn.AJt~ration or Relocation
111.) I"'tKIVIII_~HALL EXPIRE IF THE WOD,v.
AgOQJAmnScOl:I~ 1\')\)7.00
. I' llT1'f1LIL~CU '{ll THIS PERIVIII I~' NO"
cg~lrvfflreE'b s. ~ 79.00
AI\J4Jl~~It1A~ . &BANDONtU ~UR $114.00
Over 600 Amps or 1000 Volts see "B" above.
v"""4IW11$l'11N''''%J''''''''''''i;F''\t;,<;;,;.~''''J~0~F;mn]fl~a9b)j~it"')B\i1_" ... -.-.. .. '%htm"...-t&!Ki"-~----~~-"'-
D. '~Branch~€itcuiiSiIi;&@i~"ill!~i!18~:KFZsnv:mg:~RJPg . ---8'" b!Z4IT:s&$%'nffi?WP' i'MriEF1
~._'~__,.._m_"_~""-;,,,".._,,_"."'''''ro"_,,":JRilli'!llliS~W.L_1h,,,=.%li)ji;ifI~''''J>,,%$t_ - \i3h"",'0%
New Alteration or Extension Per Panel
. One Circuit $ 50.00
Each Additional Circuit or wi!h '.
Service,t;rF~.!'dI}(jI~egon law requires li~:'o19
follow rules adopted by tne ureyun Utility
, rC~:~:~!l]'!!!il-.,,,,,je~.,,,_~-l!ilhs'''''''~~'lilil
J!:. Ei\1i~~~1!'~1j~!fff.~<i~_lx~.!;l!)~~~.!;,IJl~~I}at!\!~1
gp\l..Q,~You may obtain copies of the rules by
. Pump n.~MIi\~a'Wie center. (NDt". tho tole~WhQO
SignlO~t!d_l'l1e Oregon Utility NDti~IOO.
Limited Energy.4lilli\lilrntm~ -800:332.:2344)'$ 29.00
.Limited Energy/Commercia] $ 52.00
Minimum Electric Pe~mit Inspection Fee is $52.00 + Surcharges
4.
] 2% State Surcharge
, ] 0% Administrative Fee
, 5% Technology Fee
TOTAL
Shared Drive(T:)/Building ForinslElectrica1 Permit Application 7~8.doc
C:nstruction .Contractors BO'~t.d.i '. Permit#: ex- --'cx)s S l
700 Summer St NE Suite 300 Address: /22'Cj 'i 3, rs. -r' .
PO Box 14140.- ", " Ji-.: "/ I.
Salem OR 97309-5052. ]ssu~(WM' ':. - Date:/())/ iJ jOr
Pho!'e: 503-378-4621 / L\'
Web Address: www.ccb.state.or.us
Statement: Information .Noticl to: roperty owners.
I. . . '. _" .
About Construction. Responsibilities
. ~. ." ~r --:. .;. .'
" . Note: Oregon Law, DRS 701.055(4) requires residential constructionpermii applicants who are '!ot
. licens~d with the Coniltructio,{Contractors Board to sign the/ill/owing statement be/orea b~ilding
penizit can be issued. .This statementis'required/or:resideniial building, elecirical, mechanical and
. plitfnbing permits. LicenseiJ.architect and engineerapplicanis, exempt from licensing under
:,ORS701.010(7), neednots'ubmit this, statement.. This stateme1Jt.w,ill,be filed with the permit.
-,
~ .... ' .
. Fill}nth~ ap~ropriilte blanks and initial boxes I and.2,andeither,box 3A or 3B,
. '~'I.; I own, reside ill, or .~ill reside inthtrcompleted:structure. .
.. ,-.
:0 :2. Iunderstartqthat I must become licensed as a construction contractor'ifthestructure is sold or
offered for sale before' or on completion. '
!~ -
" ;,
O. 3A. My general contractor is
"
(Name)
(CCB #)
., .
I will instruct my gemiral contractor that.all subcontractors whO work on the stnicture must be
licensed with the Construction Contractors B~ard_' . ' . ,
. OR -
&' .3B. I will bemyoWJ1 general ~ontraCtor.' ,( ~tC~iY2U'~L):
In-hire subcontractors, I will hire only subcontractors licensed ~iththe Construction Contractors
Board.. If I change mymind and hire a general contractor, I will contract with a ,contractor who is
. licensed with.the CCB and will immediately notifythe office issuing this building permit of the.
name of the contractor. .
>, ' ...", J.'.. . -
I herebx ertify that the abo e information is correct imdthat I haye reail and do understand the Information.
bout Construction Responsibilities on the reverse side of this'form.
, I' - . ~: ,> " ~~ . . '. . .
'10- / () --OS>
. (Signature of permit applicant) ,.:, :,(Date)
(White (:opy to issuing agency permit file,pink:copy to ajiplic~nt.)
,
" -,
"1.
. - ~ t'
. '1
~roperty_owneLdoc 06-01-04 .'
"-.
~
,~ .
225 Fifjl} Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2008-0095I
COM2008-0095I
COM2008-00951
COM2008-00951
Paymerits:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Pelm Serv/Fdr 200 amps ,or less
+ 5% Technology Fee
+ 12% State Surcharge
,
+ 10% Administrative Fee
Paid By
LORI M. WEINHOLD
,
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200800000000001492
Date: 10/10/2008
, -.
,
., 6 I
- .
.
Item Total:
Check Number Authorization
Received By Batch Number. 'Number How Received
NJM
991
In Person
Payment Total:
Page I of I
8:11:32AM
Amount Due
73.00
3.65
8.76
7,30
$92.71
Amount Paid
$92,71
$92.71
/
10/10/2008