HomeMy WebLinkAboutPermit Electrical 2003-7-31
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.." ;,~' CITY OF SLmGFlELD, OREGON C)
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541l)171ltlid6ollD projeclas Subm'tt d h
zon> I 9 as the 'Ollowing
ELECTRICAL PERMIT APPLICATION app;~~'a~nd does not raquira specific land use
City Job Number (;U:=Z-oos-oOi8'/ Date '7-Z-C(--03 Zonin~ ,"-'he
I. LOCATION OF INSTALLATION 3. COMPLETE FEE S8mUULb nutHI' 1- 31-03
Authorized Signature ct\'uJ
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
40 I Amps to 600 Amps ,\O~ '-~tI,,\ " $100,00
Over 600 A,mps or I Rill), 'V~~~~(\B" above. ,
D. Branch Circflitl.~~0~O~ tJ0,-"I.J:JO
~\ 0' ~0 ~'!; '\
New AltS\""~o~& ~erts~oll!P~\~nel
OI}~I!,i.iO\,0'~;01" ~0\,o~~~(\ $43.00
.-d:ch 6'UlIiri~~1 Clfrt<?iit:~'w;lh0'\l ~,"'
~\'{::~;,ci ( ,,<,' ",,:Y' ~'-"" .~,c. $ 300
~~ :-.W.:~~6rF~der~@iii\,,-"<,0 ~o~ .
p ~,~ ~ 0 ~~ ~~~ ~o'-\~"<:A '"rJ.'\' .
HG./-#O. c.~O ~~i"l~eM'fl'J&,~ I(S~).1:11l'~; not inclnded) -Each Installation
O~~ ~~ ~~0' c.0~~0,0ct,f::Jt::)-'5
~~o~()~~ ~~glitlpn\'~ $ 50.00
~ "t::)~. ut'ilhe~]';'ting _ $ 50.00
"c. ~'e"
~ted E/iergyiResidential ,/ $ 25,00 v z-:;-
Limited Energy/Commercial $ 45,00
Minimum Electric Permit ~nspection Fee iS~ Surcharges
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LEGAL DESCRIPTION
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JOB DESCRIPTION
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Pcrmits are non-transferable and expire if work is
not started within .180 days of issuance or if work is
Suspended for 180 days.
CONTRACTOR INSTALLATION ONLY
2.
Electrical Contractor OJdf;')-J J "
w in
/NC--
Address
/ 4{,'("
City ~'ilA-.<..
Phone b '1:~S-(.oDO
Expiration Date
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Co ..- () 1- 2A)s
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J 2-'1 I? (,
GAlo'
Supervisor License Number
L-fA.
Constr. Contr. Number
Expiration, Date
G,-q '-Oc,
Signat~I~~
Owners Name (Jh~ vt ~<;dqv
7t.rQ JIl/f'-KcN.eIC
Address
City
s? F '"
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
ponion thereof
~ $106.00
~ $ 19.00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
B. Services or Feeders - JnS(~l11~~'\Iterations or Relocation:
. ~"\'(I ~ ,S
200 Amps or less ~~V" ~'V:-~ ~'\}'V:-
201 Amps to.'l.~'i\i~} 1::J~v"~
42.,1 Am~S#WR:.,?-~~~\l
~'\,%~~~'titt\ll'l~<R~~~
\:~\-t9~~ooa~~~
,?-\}Ri ~~*~
\.,\)~ \'O~. .
C. ~porary Services or Feeders
$50,00
$ 63.00
$ 75,00
$125.00
$163.00
$375.00
$ 50.00
4. SUBTOTAL OF ABOVE
y(
3,/5""
'7 :;-0
~5Z_"~
7% State Surcharge
10% Administrative Fee
TOTAL
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Shared Drivc(T:)IBuilding Fonns/Elcctrical Pcnnit Application 1-03.doc
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City of Springfield
Electrical Permit Attachment
"
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.: ELE2003-00181
ISSUED: 7/3012003
APPLIED: 7/30/2003
EXPIRES: 1/3012004
SITE ADDRESS: 7610 McKenzie Hwy
ASSESSOR'S PARCEL NO.: 1702354101401
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Residential
PROJECT DESCRIPTION:
Low voltage
OWNER! APPLICANT:
KNE[SLER CHARLES R & JOAN I
PO BOX 70231
EUGENE OR 97401
ELECTRICAL CONTRACTOR:
OLDFIELDS INC 541-485-6000
1465 W 7TH
EUGENE OR 97402
CCB # 129736 Expiration Date: 06/09/2006
Descriotion,
Amount Paid
Date Paid
Receint Nnmher
+ 10% Administrative Fee
+ 7% State Surchar~e
Low Volta~e - Residential
Minimum/Adiustment Electrical
4.50
3,15
25,00
20,00
07/30/2003
07/30/2003
07/30/2003
07/3012003
1200200000000001865
1200200000000001865
1200200000000001865
120020000000000[865
~
~~~
.~ -,\:)
To Request an inspection call the 24 hour recording at~1z~~ll inspections requested before 7:00 a,m. will be made the same
working day, inspections requested after 7:00 a,m, ~"b~~~eane following working day.
_{~"I _ 'XX; _,;,.~
V ~.1 'N.J
Reouired Insoections: -x-{;y 'X:-'" &~
1 Low Voltage: Prior to co;:er. ~ c:,.~\:)X; {:> "f' <'..
t;V' ~ " ~ ~v ,0
By Signature, I state and ag~)ihil'fl~~e'~)\~~y examined the completed apPlicatiol\Cll~{l.z(I~ It..ereby certify that all
information hereon is truei'a'nd,co)re'Cl, an~l-turther certify that any and all work p'.llform'e'l'i 5h'illl.he done in accordance with
- ',,"' ",-. .,....s;,<' \'l' d"~ "'" ('\.\.J'
the Ordinances of the City of'Sprlngfi~d' ~.u the laws of the State of Oregon per~IIUll(O~}ie Wpl"K described herein. I further
certify that only contractors an"d~'l!P~'1Y~s who are in compliance with ORS ,~.{lf.2,5S'W.jIllii~tffii~'O~ tJJis project. I further agree
to ensure that all required inspectlo~'\llre requested at the proper time, t~.a,t>~~~lNIct~~ ~"ad~<r~eih the street, and that
the approved set of plans, if applicable, will remain on the site at all ti~l<f.(I~~sOn~\j;oc\!p'l1'0-0~",V~
~9 ~,0,,~ ~O '~0'" 0~ O~
",-,0 ~~,o.0\' .~oI$' r~~ ..'!S'..~~ ~"\.
~.... ~0" 00"Dliil! ~'~O' ~~.. !IP
~ ~ \~ O~ s:J:5' ~~ 0\'~ O~ <:':Jf':J'/;
'~'SIo0 ~ b'/; ~~ ~ 1o.0CfJ<;::,r:::!
....0 ~\CJ g;.Oj >><S' ",v0 00 ,!1:3
~O O~ -\.0 ~oI$' ~oI$' ~\'i>
.~ f:)o.P',:j~ ,lO 0~0
Cl v~"Q C;
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Owner or Contractors Signature
Page 1 of 1
225 Fifth Street"
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 181
ELE2003-00 181
ELE2003-00181
ELE2003-00 181
Payments:
Type of Payment
CreditCard
Paid By
OLDFIELDS
.Bl
Receipt #: 1200200000000001865
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Low Voltage - Residential
MinimurnJ Adjustment Electrical
Received By
djb
Check Number
Batch Number Authorization Number
000132 030795
City of Springfield Official Receipt
Development Services Departmenf
Public Works Department
Date: 07/3012003 2:19:09PM
Amount Paid
Item Total:
3.15
4.50
25.00
20.00
$52.65
How Received
In Person
Payment Total:
Amount Paid
$52.65
$52.65
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