HomeMy WebLinkAboutPermit Electrical 2003-8-8
:" ~ CITY OF S,--,lrNGFIELD, OREGON. 0
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689b ." dhasthafollowing
The followmg project as su milLe
ELECTRICAL PERMIT APPLICATION . zoning. and doas not require specific land use
City Job Number t;LclDOJ - 601gL{ Date &/6163 approval. . (!,V
~ "I ~ Zoning ,_I \JlL
1. I LOCA110NOFINSTALLATION ,I 3. I COMPLET~lf!-F.p...rupnl}I.KHEl.~':'~~d
c/o /.5 !f)a/f) Sffee:f "umonzec Signature . .
A. I New Residential- Single' or.Multi-Family per dwelling unit.
LEGAL DESCRIPTION
/702.. 5/Lf!
O{,g'oa
Service Included
JOB DESCRIPTION . 1000 sq. ft. or less $1 06'~
..J n Each additional 500 sq. ft. or . ..
Ilbl~ 5 (2.-.tL '1- U e.u".h. ,J-...tz... 0.... T5,;:'C p6tf;dd:il\~TJ6fN;()regon law reqw.rQ~ "~"It 19.00
I ~\c.,..-T'IN&- fol ow rules arlnnlprl h th 0 - --: .
Permits are non-transferable and expire if work is ~ "anulhct 1tHome'Ot"Y aragon Ullhty .
not started within 180 days of issuance or if work is . I I ~PBQ,~Ilil,rgtS'll'\TJeQ,'Fa rules are set fl$~o 00
Suspended for 180 days. I If,\ 952-001-0010 through OAR 902-00 .
OQ~"" ~~'j ~l;l-'-" .
I . .... r - 1 " .. ~. .:J. _" I. vUfJl'Q';:).UI U1B ru'e!=;, I .
2. "CONTRACTOR,INSTALLATION ONLY B. CSlllmg.'fl~ !:~trf.li'mf.'lllP8~Ili>f.!~~~!.tl~IS or RelocatIon:
. /) ;;::= / J _ -- numOer for the Oregon Utility NoWicat' .
Electrical Contractor _"'1"rC cJt' cry Jr .0c 200 Aml€enWPis 1-800-332-:'::;:;.;j. ~'lf3.00 Co 3,00
. 1.1 201 Amps to 400 Amps $ 75.00
Address >tt::; 7 >{, '3 AluJu 9 '9 SoL/'-l"~ 401 Amps to 600 Amps $125.00
_ 0 . 601 Amps to 1000 Amps $163.00
City !:3U.4f1I1-L Phone -JV/....OY9Y OvcrlOOOAmpsNolts $375.00
J Reconnect Only $' 50.00
Supervisor License Number
0-''0 7 9S
c. 1- T('mpora~y Service{ or:Feeders
Expiration Date ) D.- / - 0 y'
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
Constr. Contr. Number .2 ~ - c;/ 0 3 C
)0-/-0 '3
Expiration Date
Signature of ~g Electrician
I~
l/
Over 600 Amps or 1000 Volts see "B" abovc.
D'~e~~~~~~~JfjJ~~fJ~~::~n~~gN~~~V ,I
On.,\l@fMh3Hl :1/ 3l-1::>1 1 ~]ONn m7/Lj~41qO> .
Each Additional clrcuNgi<~ith1\fHS 1/1Aftt] . ~ I lJ '5" ~
Service or Feeder Permit ""J'v. is ,!oq /
.:J:11( (lU
E. I J\'ljscellaneo\1S (S~rvice/feeder ';'ot in~luded)'::EaclilnSl.allation 1
OWllers Name fill I fl..,A-VlA. -S-'':Wt:- '::,
Address \.;()( \" .M #Irlr S ~
City S j) r I"" Phone
OWNER INSTALLA nON
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
The installation is being made on property I OWll which
is not intcndcd for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
OWllers Signaturc:
4. I SUBT9TALOFABOVE
,
1-'.:
1/.'00
S-.r/~
'1.f?b
qJ.;;'~
Inspection Request:
'~J0~
726-376~~~~0 1\ ~.
\J\\J~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FormslE!a:trical Permit Application 1-ll3.doc
~'-
Date Paid ~o .,,~~ A Receint Number
0'" ,,)'" ,-
08/06/20030o.~\~ ~o(;<. 'O0\. \O~~0020000000000 1351
08/06/?9.0j 0,0 ~,0 '?J~'/; 200200000000001351
o8iP,612(j0~\0 ,s.0'" ~<?- ,,s.<2 %>200000000001351
..O~<g!O~~0 ~ ,r>~ 0 ~\ ~~~o~J~OOOOOOOOO 1351
. u'.' ;..,oy ." ""'v' . 90'" ~"" .!\.\V-
To R~quest a~ inspe~tion call the 24 hour recording at 726~37~ ~i\1!lihS,P"t,~t~.{l~'re~R-~te~~~ef~c.9;oO a.m. will be made the same
workmg day, mspectlons requested after 7:00 a.m. wIll b:\m<atl~t.h~fqJ)O~.(!l8''':'.....'Wclngeay.~~ ~riiI'
I" ,\O~ ..\O'C-_.OO \ o'Q ,(.~.<\ 'J _I')fl;
,~ '1\\'" '?J'?" ~D-l f<-.'- 0~~ ;:J~
Reouired Insoections: ~O~OI"<?- ~o~ 'So-0v000\!OOr::,
'f<-. Rl (\'I. ~.'" ..t
1 Rough Electric: Prior to Cover ~ Rlq) . ~\'C-.... ~ \0' ~0' \ \)~~
2 Electric Service: Approval required prior to utility co~pali? !(~~iZfdlf'service. ,\~x.. ~<o ~\)'\
3 Final Electric: When all electrical work is complete. 'C--:i ~\~x.. t~~\\ ~\)~ .
By Signature, I state and agree, that I have carefully examined the completed apPlicati~'\.I!.r(~l!~~eby:.);lrtify that all
information hereon is true and correct, and I further certify that any and al~!lrkfeSfotm....O!I sha!!,~\Jdone in accordance with
the Ordinances of the City of Springfield and the Jaws of the State of Ol'ti:'Jri pr'" ~!N~fJ the '\v'6rk described herein. I further
certify that only contractors and employees who are in compliance wrth'ORS'7 i:05.'5'\wil11Ji~.ell'on this project. I further agree
...V\'" ('\, '" < \ .w..'"
to ensure that all required inspections are requested at the proper time,\tha~fadi a~d_drejs\is-i'eadable from the street, and that
the approved set of plans, if applicable, will remain on the site at all time~'d\Iri~\'c'.wij'n1ction.
c,\)\; \'O'J
"'~
Date
;- ..7a,
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:
JONES LARRY D & MIRIAM L
4015 MAIN ST
SPRINGFIELD OR 97478
Descriotion
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Owner or Contractors Signature
.
.
City of Springfield
Electrical Permit Attachment
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00184
8/6/2003
8/6/2003
2/6/2004
4015 MAIN ST
1702314106800
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
Add service and circuits for outside lighting
ELECTRICAL CONTRACTOR;,
ARC ELECTRIC 541-741-0494
85783 HWY 99 S
EUGENE OR 97402
CCB # 115113 Expiration Date: 07/1 1/2004
Amount Paid
7.80
5.46
15.00
63.00
Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00184
ELE2003-00184
ELE2003-00 184
ELE2003-00 184
Payments:
Type or Payment
Check
1Iii-.:..~'.."'''.~~'~'= ~".',".'l,
..,..' !
" . -;
- '. > .'
__.'"".........~. ......" .,,~._."-; --c'
Receipt #: 2200200000000001351
Description
Perm Serv/Fdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
ESTATE OF ARC ELECTRIC
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt
Development Services Department \
Public Works Department
f
Date: 08/06/2003 10:30:29AM
Amount Paid
Item Total:
63.00
15.00
7.80
5.46
$91.26
How Received
In Person
Payment Total:
Amount Paid
$91.26
$91.26
.
.