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HomeMy WebLinkAboutPermit Electrical 2003-8-13 . . "'r<r;';c"~"t,~~~1itTY OF ~ tlNGFIELD 'OREGON '\ r ::~.< " . ~4 t" 'i"" \ ~~ ~ '" ~ ~, / ~,I , I" '1 , k "<, , j ~ , j. 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX'TI(~U~cf as submitled has fhe following ELECTRICAL PERMIT APPLICATION ~~;ir~g~a~nd does not require specific land use City Job Number ~ZOOJ - Dol%' Date . fl.! tI / 6~ Zoning Lt\iZ- . . ce:., 1~""o.3\ 3. COMPLETE FED'McHEDULE BELOW ,..,t t-J Authorized Signature '1"' B. Services or Feeders - Ins~uation, Alterations or ReloclItion: ~0'" ~0'U\~\\~ i' Electrical Contractor Co...... it c..rt uc. '/Z/<.c.f' "'.... 200 Amps or less 0o.\)~ ~o~ ri\O C" ~ 20 I Amps !\,\<iO~~~~ 0-,0 ~<:>VU~ "- Address rzg<j{) '/ STE.PhE.n5 I2d 401 Anl~kw()O A!'iP~"'O~~ ,\)\0J r 17 ~9'~ ~0 ~..0 ~ ~0 0' ~ 171/70 . :\\)601 ~nlPs t,\\lwR~ps 0' ~0~'(I: ::>0 City \ AJ _ DR.. Phone (5"1/) 7t/b-toi.f.,~J-.(),;/lrJ,pOd~tfip'frv.~fs0~~0\~,0\'~'v , . I" ,:I' Re&; ro r~v ~0' ",~:\ 2. C) ;;J.. '3 S '0\\0. 0-\.w' .&J"'c o~~y; ~o \)\.~\'1 '?J<b' . ':;J 'I..'\'V ~ q<:>"t <<\-a.'l ~0" o~ <'l..?;?; Supervisor License Number ..."l ~ ~~ ~O O~~-{J.e~r.i~\~ler.f~~b}'Feeders f f \~r::iq~' .~~~ ~~0..c,'\' Expirafion Date I 0 c:> \ .;2.0 C t.{ (l c:i;'~!IJ~~I/:'~lleration or Relocation Lc.5 Isr.-s 3.;L ~&1 Amps or less . $ 50.00 Conste Contr. NUmber)t.,~LVYI-r. 11 .:2(") -S"O?G 201 Amps to 400 Amps $ 69.00 c/ 40 I Amps to 600 Amps 'j $ I 00.00 Expiration Date q: 7 Gl Over 600 Amps or I 000 Volts see '~'Ilb~~~;' Signature of Supervising EI~ctricgn D. Branch Circuits AQ\~fr,.~\l~' ~~ fJ _ A--"""-----. New Alteration or ~tsmW Cl . I <.::r~ On~~~..uit.\~ S"'~~~'" ,'tI ~\)~ $43.00 L.f 3. 0-0 -- J-~M~ LlSC;fWSfCh \EafiJ\\A."d~~I@l)l;\ll.~~t t1 f ~~rY-!f't"J~~r~'\l',,'i). $ 3.00 Owners Name !i.&i l \'0\",\j~ "f."fr,.\) ~~",\V Address . .l;11 p_ ?tAri~~. ~. ? E. ~~\~ill~'iS~ervice/feeder 1I0t illclllded) -Each IlIstallatioll City fA-/o M.:h- . cAPhone 'bso' ']ZL-@??f Pump\b,;\1rrigation $ 50.00 .. . 1 - - Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee i~,\:oD Surcharges 4. SUBTOTALOFABOVE 'i \' 4'5.00 7% State Surcharge '3 I r "1 . 0 ( 10% Administrative Fee ~ ~~ .4. 773/0 TOTAL "L5~}t-' \_ J ~ .::::::::--'50. ;) Shared Drivc.:(T:)/Building Forms/Electrical Pcnnit Application (-03.doc I. LOCATION OF INSTALLATION t.. I D ()a (P.. Y'Ja./~ LEGAL DESCRIPTION \ 70322 '-fZ JOB DESCRIPTION 07 goo tetf'I4.c..;..., "? 1,?W1 ;..... ~tC."l~. Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY 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 ullit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion tllereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 , . . . City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Streel Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00187 8/12/2003 8/12/2003 2112/2004 + 10% Administrative Fee + 7% State Surcharge Add. Alter. Extend Circ Minimum! Adiustment Electrical SITE ADDRESS: 610 OAKDALE A V&\)\~~\ ",'I . \\{\~" . ASSESSOR'S PARCEL NO.: 1703224207800 0.\),,0 o~ v ~ v:l" . ,:I ,e ~0q, 0 '00 }:)~ PROJECT DESCRIPTION: Add l^h~~~0~0",_-a.:~q<:>:.\\~", ~ OWNER/APPLICANT: . \O~~~~\0~~0"''dO~~X\ vo' ~~,".~eE~'FRICAL CONTRACTOR: """~ 0-U 0" ~, '~0'" \0' .M','" LlSCHINKSYDAVIDTE:0~ J-.0"'(j0~ r::i'\~ vo~ .~0 ~d>0NNIElEROYJENKINS 541-746-6441 410 STANFORD AVE ~ 'o-tl'. o~ R)""-O ~i\~ _\0\0' ~\~ ~l!!l.404 STEPHENS RD P LO LTO CA 94306 '0\\ -a.\~ f).a 0'0 ~ 'U~ f)~ SPRINGFIELD OR 97478 A A :"o\~,v a,q'j" ",0-~ 0~\0"0~0~ .,?>'?>?;'" CCB # 156582 Expiration Date: 08/0612005 ~ _b...~' ......u _C f"\~ ,,(:\ '.{\ e C ' ^ \\\- to"{\'a \",6- ~~~ . ~Amount Paid,,,, v'l> . ~0\' ^",'-"" ~~ 4rsO' (\ 3.15 43.00 2.00 Springfield TYPE OF WORK: TYPE OF USE: Addition Residential Descriotion Date Paid Receint Number 081l2/2003 08/1 2/2003 08/12/2003 08/1212003 1200200000000001944 1200200000000001944 1200200000000001944 1200200000000001944 To Request an inspection call the 24 hour recording at 726-3769. All inspections ~~~~d before 7:00 a.m. will be made the same working day. inspections requested after 7:00 a.m. will be made the fOllowin~~~~h"'~\ -~. \~ .,,\ ,';, - ~"~. '\:..'<"" 'i;\)'" Reouired Insoections: ~\.\. <;;.~,,\';, '( ~~<;;.~ 1 Rough Electric: Prior to C~ver \'V~.. ~ ';,~~~<;;.'?> ~'Q~~'V 2 Final Electric: When all elictrical ~ts,\,~~~ '\) f\'?> \';, ~. '\,,\~ ..;~~ iV ~<0 By Signature, I state and agree, that I have c ~Dl:~1 ~f, ~&H:e completed application and do hereby certify that all information hereon is true and correct, and I~urt~~Cet11 that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and th't~a\v~'\lf the State of Oregon pertaining to the work described herein. I further certify that only contractors and employees who\il'i; 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 the approved set of plans, if applicable, will remain on the site at all times during construction. Owner or Contractors Signature Date Page I of I 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number ELE2003-00187 ELE2003-00 187 ELE2003-00 187 ELE2003-00 187 Payments: Type of Payment Check -Wit.~"'.'~'~~.~'"""'l ,"'''- . i , Receipt #: 1200200000000001944 Description + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Minimum! Adjustment Electrical Paid By MCKENZIE TAYLOR CONSTR Received By djb Check Number Batch Number Authorization Number City of Springfield Official Receipt Development Services Department ~ Public Works Department Date: 08/12/2003 2:10:29PM Amount Paid Item Total: 4.50 3.15 43.00 2.00 $52.65 How Received In Person Payment Total: Amount Paid $52.65 $52.65 . .