HomeMy WebLinkAboutPermit Electrical 2003-6-27
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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
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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\)\\~
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Owner or Contractors SignatUre' ....
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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