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HomeMy WebLinkAboutPermit Electrical 2003-6-27 i" 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FA!~!oj~.fl~?1iI~9S submitted h~.sthetollowing zonmg, and does not require specific land use ELECTRICAL PERMIT APPLICATION approval. .City Job Number m7co3~(J= IbO Date oG2-I, 03 Zoning );])e. Date 1.-f).7vo~ 3. COMPLETE n:E SCHEDULE BELOW ,.w.. , Aillnorlzea-srgnaturp "-1""\f/'...J 1;" n - / New Alteration or Extension Per Panel /:..;?/~ ;/ ...yodJ One Circuit :.. ( Each Additional Circuit or with Owners Name CA'Ycc:/..u ./1I::>~/)I\..,.l Service or Feeder Permit ::L' $ tOO Address I eft) 'i 1" e 0 ~ (J'?-.'f.. E. Miscellaneous (Sen'iCe/feede~~:otin,c1Ud.~d) -~~c~ Installation City 3/,...., Phone -.2!t1-d.7-'*'t'l ~(J\ Pump or irrigation ',' .<. j~ $ 50:00~. V' 1i'~ '" ~\\ ,S Sign/Outline Lighting ,"' ,.~. '$ 50:00 _:.;-,. OWNER INST ALLA nON ~\.. ~i--'?:s '?~~~~\) \(J'?-. Limited EnergY/ResidO~tial'V . $ '25.00 ~". c..'t::.::.s:\..:' ",\(\Q) Limited Energyid,~. )m~~~.iar. ..'. . '.$ 45.00' The installation is ~~i4~~n'~;::Y~"''ri'WhiCh ,,~_.,., is not intended\Q.~\r~~'illI~~rs6lll.1i' ,S Minimum Electric Perlnit Inspection I'ee'is.$45.00 + Surcharges ,\'(>.\'0 C\'?-.,...'C. x.\) Q) ~(J\)' 't'. ". . . , Owners Signature:\>.'0'\~ ~~~\J ~ '?~ 4. SUBTo'TAL OF ~OVE . c,\)~ \ 'O~ \) . J. ~ . \'~' 7% State Surchtrge . J 10% Administ;;tive Fee-'"' \... ,,~ 1. LOCATION;;' INSTALLA110N /0/'0(' e/J.lJrMf LEGAL DESCRIPTION /703253 Z. 03:500 JOB DJSCRIPTION ~Pf.rJ/~~ IhnA/)~ Permits arc non-transfe~re if work is not started within 180 days of issuance or if work is Suspended for t80 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor K ~ lEt l!' ~~./i Address If..o. 0(-,:" :1 ~93J City F.AL-AA4..L Phone htf(P'6 ~J /. V esupervisor License Number 3 1.(9'7.s Expiration Date /~// 111 Y Constr. Contr. Number 7D-r J- '] Expiration Date . n/3~/63 Signature of Supervising Electrician Inspection Request: 726-3769 A. Ncw Residential- Single or Multi-Family per dwelling uuit. Service Included 1000 sq. ft. or less Each additional 500 sq. fl. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. Services nr Feeders - Installation, Alterations or Relocatiou: 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpslV olts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 bJ c. Temporary Se-rvices or Feeders 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 Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuit"i $ 43.00 b TOTAL /"'7 yO ;., 'Ie> ~07S Shared Drive(T:)lBuilding Fonns/Elcctrical Pcmlit Applicati~n I-03.doc t." ..'" 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: THOMPSON CAROL DEAN 1404 PIEDMONT ST SPRINGFIELD OR 97477 Descriotion + 10% Administrative Fee + 7% State Surcharge Add. Alter. Extend Circ Ea Add Perm ServlFdr 200 amps or less . . City of Springfield Electrical Permit Attachment PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00160 6/26/2003 6/26/2003 12/26/2003 1404 PIEDMONT ST 1703253203300 Springfield TYPE OF WORK: TYPE OF USE: Alteration Residential Service upgrade ELECTRICAL CONTRACTOR: KS ELECTRIC 541-686-6236 PO BOX 24933 EUGENE OR 97440 CCB # 70889 Expiration Date: 12/30/2004 Amount Paid Date Paid Receiot Number 6.90 4.83 6.00 63.00 06/26/2003 06/26/2003 06/26/2003 06/26/2003 1200200000000001648 1200200000000001648 1200200000000001648 1200200000000001648 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 InsDections:, 1 Rougb Electric: Prior to Cover 2 Electric Service: Approval required prior to utility company energizing service. 3 Final Electric: Wben all electrical work is complete. By Signature, 1 state and agree, tbat 1 bave carefully examined tbe completed application and do bereby certify tbat all information hereon is true and correct, and I fu'rtber certify tbat any and all work performed sball be done in accordance witb tbe Ordinances oftbe City ofSpringfield:~nd'tbe laws of the State of Oregon pertaining to tbe work described berein. I furtber certify tbat only contractors and employees wbo are in 'compliance witb ORS 701.055 will be used on tbis project. 1 furtber agree . '. to ensure tbat all required inspections are requested at.tbe proper time, tbat eacb address is readable from tbe street, and tbat tbe approved set of plans, if applitatiie, will remain on tbe'site at all times during construction. X-. 't'l\)\\~ " '.~ . ,~,Y' \S ~(J ~ . .... . ~'IO~~ ",,\J\\' -[1 ~" Da~ \>.'-V.... ~S \''''' X-.\) ~v' . "./',~ ~,,\\CV . ~\\ S~~\)~\\ ,Y' \>.~'iJ(J~ ,.... " . . ~'0'S \>~~\1..~\) \l (J'?-. ,S ~ \>.'0\'0Q) X-.~c.,~\) ,?~\\,Q) . c.,(J~~'O~ \)\>.'{ \>.~'{ y Owner or Contractors SignatUre' .... .... \~. :.oJ ,. ' ". ~'J ,. ',' ;)' 'oJ . ,,' . , <' ., ,,' . . (, Page I of 1 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number ELE2003-00t60 ELE2003-00160 ELE2003-00160 ELE2003-00 160 Payments: Type of Payment Check . .. ." ,. , ~~'t;,"'~ ~I ~, ~ti, ,! Receipt #: 1200200000000001648 Description Perm Serv/Fdr 200 amps or less Add, Alter, Extend Circ Ea Add + 10% Administrative Fee + 7% State Surcharge Paid By KS ELECTRIC Received By djb Check Number Batch Number Authorization Number City of Springfield Official Receipt Development Services Department Public Works Department Date: 06/26/2003 1:19:11PM Amount Paid Item Total: 63.00 6.00 6.90 4.83 S80.73 How Received In Person Payment Total: Amount Paid $80.73 S80.73