HomeMy WebLinkAboutPermit Electrical 2003-8-13
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. "'r<r;';c"~"t,~~~1itTY OF ~ tlNGFIELD 'OREGON '\ r ::~.<
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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
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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
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