HomeMy WebLinkAboutPermit Electrical 2003-3-18
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 0 FAXi'~7'l?i23/llllJ hot ~'"'::;':i' -;':'"t-,';, :
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ELECTlUCAL PERMIT APPLICATION, , ZOhlhg.'---- 'j' _ _';
City Job Number ~t'DS-N).Q70 Date $/ ;:),C)O~ate . -:;- Ci>--O ~td
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LEGAL DESCRIPTION
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JOB DESCRIPTION
r'{vJ:V( /-0 .~ ,1 ~GfY) no
Permits are non-transferable and expire If work Is
not started within ISO days of Issuance or If work Is
Suspended for ISO days.
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Electrical Contrnctor C ~ S f Ife-trlc.. I ~ .
Address r. D. BDX \L'~7_
City ~{\Y\dJdJphone J41-22~
l\I.nJ~E: EI14~th<m: WORK
Super'Yikb censelljl~bet l ;Jtl()t'Wl"-!..:>- _ "nT
THIS tK1V1 "'::1', Ti:lIS P~I\i' I iv "u .
Expira'l,\lJjj~t~'Z_E?~ U~Pa c,b1l1;-.lU&aro FOR
COMMb~t.L.Li v-' ,- -
ConstrN;b'h~.PN'1lrl~~r PER\3ls L/ q
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Expiration Date
Signature of Supervising Electrician
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ownersN81lIelnl~ 0fY\ ~~
Address \ ~ C\ n fu (~0<\C\(", \
Ci~\o.. - Phone/4( n -9aleS
OWNER INST ALLA nON
The installation is being made on property I own which
is not intended for sale, lease or renl
Owners Signature:
Inspection Request: 726-3769
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A. ~!~_ili.t!!ligOO!JlejY!IP~~\tg1iwyJit
Servl.e Induded
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
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$106.00
$ 19.00
Each Manufact'd Home or
Modular Dwellins Service or
Feeder
$50.00
B. ~~~fj~f?F1~~FS'4irlnJif"Il.ut''''p 1'l~,,,~ 'llbhi)';'~'R~jbCaU"Il! L- ~
~~..~ct.~,<<~oJ" --U,:"h>': ""lb". 11' lA' . ,.1'~.~t.i:-'.".'~1 .. ..." ; _'I<( ~. '-':',~ -'. ,~"J
(/J~ .'CfJ
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
401 Amps to 600Am~u.. ,oM '"lilli''''' )'JISt'i5.00
/"\1 . 1-'-' ~. .~. -- JtllllV
6ml~ps.lo?1000'wn\psJ by the Urt:lYUlI~:ln~~,oo
IOverII000:AnlPStW6IiS Those rub,: ~:",v"r,$375.00
1\~~~~J~QnIYJ1-0010th~OUgh ,-,n" ~.Jc$5.o.iJO
~f'\o(,\ VI"'oII rnRV o,~tnin copies Ul \l I\,; n.lle::s u
C. ~J:.ffi.il!S.~ltiM~~!!!d.~
numberfOithe Oregon OlllllY ,"V""____
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InslalJalln'!~M~.ratlnn'or,R.locatlon' .
200 Amps or less
20 I Amps to 400 Amps
401 Amps 10 600 Amps
$ 50.00
$ 69.00
$100.00
Over 600 Amps or 1000 Volts see "B" above.
D. ~r~~~~~~~,Jj~,j~)'~~~S:i~:4~q;;;$jW\:11'r:~~JeJ;{;~;;.:~,~:,~
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Pennit
$ 43.00
$ 3.00
1J..... 60
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E.I~~.~~~fffi~~)~I\tfit1~_
Pump or irrigation $ 50.00,
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
MInimum Electric Permit Inspection Fee Is $45.00 + Sur.harges
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4.
7% State Surcharge
10% Administrntive Fee
f=:, . CJD
S . ;) 7"S
{,50
1..1.75
TOTAL
Sban:d Driv<(T:YSuilding FormsIEIeclrical Pamit Application 1-o3.doc
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City of Springfield
Electrical Permit Attachment
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Status: missing from list
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.: ELE2003-00070
ISSUED:
APPLIED: 3/13/2003
EXPIRES:
SITE ADDRESS: 1390 PIEDMONT ST
ASSESSOR'S PARCEL NO.: 1703253203200
Springfield
TYPE OF WORK:
TYPE OF USE:
PROJECT DESCRIPTION:
Meter/Panel Combination
OWNER! APPLICANT:
SMITH CHARLES E & LOIS A
1390 PIEDMONT ST
SPRINGFIELD OR 97477
ELECTRICAL CONTRACfOR:
C & SELECTRIC 541-741-2236
P.O. BOX 1482
SPRINGFIELD OR 97477
CCB # 3849 Expiration Date: 09/01/2004
Descriotion
+ 10% Administrative Fee
+ 7% State Surcharge
Add. Alter. Extend Circ Ea Add
Perm ServlFdr 200 amps or less
Amount Paid
Date Paid
Recelot Number
7.50
5.25
12.00
63.00
03/14/2003
03/14/2003
03/14/2003
03/1412003
2200200000000000596
2200200000000000596
2200200000000000596
2200200000000000596
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day,
inspections requested after 7:00 a.m will be made the following working day.
Reouired I nSDections:
1 Electric Service: Approval required prior to utility company energizing service.
2 Rough Electric: Prior to Cover
3 Final Electric: When all electrical work is complete.
By Signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon Is true and correct, and I further certifY that any and all work performed shall be done In accordance
with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herellL 1
further certifY that only contractors and employees who are 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
strervrJ~~ ~~rc;; 1 ;IJ~f ~pp~cable, will remain on the s3( 7~i~~urlng construction.
Owner.or Contractors Signatur~ Date
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