HomeMy WebLinkAboutPermit Electrical 2003-3-31
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3t\~\tted \'I~~: land use
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ELECTRICAL PERMIT APPLICATION , lIo'J'Jil'\9 ?{o\e~'ot {e~ui{e s
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CIty Job Number ElJi. ZOO:!> - Cf::>L) (~ Date D,..-? -5 / 70~-'-'" . U ~ () ~
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1.
3q51\-\~ck.n '?x\~~ ~d...
LEGAL DESCRIPTION
/702 1900 03300
JOB DESCRIPTION
CQ..L~~e.. ~f~~
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.
Electrical Contractor d.IIL tY/OJl.Jl(,o E;lectu:.c.
Address 4'8?-' ~~ 6c
City ~(''0CJ~eJd. Phone let I-oBI \
Supervisor License Number :?f:Deo ~
Expiration Date 10 / I I ~
I j
1838
Expiration Date ~ 10 5 _Q,.~ ,
~\j'.~
Signature of Supervising Electrician '\~~ '%> ~\:i
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Owners Name G.-l-'7.< S~ ~(bye-
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Address ,^I(,.,~ ~v~ ~<y ~ \;J~,,~\S
City ~~S ~~~~~~~~~v
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OWNER INST ALf>\..~N
The installation is being made on property I own which
is not intended for sale, lease or rent.
Constr. Contr. Number
Owners Signature:
Inspection Request: 726-3769
3.
A.
-...
ii-Family per~dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B.
200 Amps or less
20 I Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
I
$ 63.00 l/::S . c::JO
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Co
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
Over 600 Am s or 1000 Volts see "B" above.
D.
$ 50.00
$ 69.00
$100.00
New Alteration or Extension Per Panel
One Circuit d'lU \~,., $ 43.00
Each Additional Circuit or wit~\,\e':l ;J.'0\\\\"1 ~';
Service or Feeder Permit ~\eO\ ~?l}O'tD",\ \C$",J.OO
:\\ \,0: e 0 ~ "e ':)- ,()O'
\<6 co
E.
....' \eS'O' t\e\' ':r:.O't:. . r: C'\ . 0'(\0 . :(\
PumP-l9t\hT1g~io'rt ~~\ () '\; o-Q\'Z~._'>. \e\e\~.!1\~~5'&00
.Si~};1RPt1'r,n6~ I!~ih1~&D~?'\>(\ ~~c\e':~~;"1 ~()~~ $ 50.00
,.)',\\ ,.>t'':'?; "''' v ~ ~"^ \~\,\'.-. ,,/\"'1'
I:iniit<1q{Ene(~y./.Res~~ntia'l r:\O'{\ ,..,('),?,:)'< $ 25.00
. '\ U "lOr, r.> C ('\~f?'!) "_JV
Limited)Energy7e6mmercialO,\I\I'~ $ 45.00
tJV- \~\\\", ~'.\'-, '\.." '
...'1).\ ,\01 ,;v',
Minimum Ele~\t\~{~;'PePl1.,flfnspection Fee is $45.00 + Surcharges
4.
8\.cO
5.L71
<g.IO
C}Lh'll
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FormslElectrical Permit Application I-03.doc
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO,:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00093
3/31/2003
3/31/2003
9/30/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
3957 HAYDEN BRIDGE RD
1702190003300
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
200 amp service and 6 circuits
OWNER/APPLICANT:
EUGENE CITY OF
CITY HALL
EUGENE OR 97401
ELECTRICAL CONTRACTOR:
L H MORRIS ELECTRIC 541-747-0811
483 SHELLEY ST
SPRINGFIELD OR 97477
CCB # 01838 Expiration Date: 06/08/2005
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee
+ 7% State Surcharge
Add. Alter. Extend Circ Ea Add
Perm Serv/Fdr 200 amps or less
8.10
5.67
18.00
63.00
03/31/2003
03/31/2003
03/31/2003
03/31/2003
1200200000000000912
1200200000000000912
1200200000000000912
1200200000000000912
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 Insoections:
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service. 'iO\} \?
3 Final Electric: When all electrical wor~s complete. \en.\}\~es {\ U\\\\\i ~\'\
('\~ d\ \e.\!'l ,()~e9P 1.:). Se\ \~ ,,-
~y Signa~ure, I stat~ and agree, that I ha,,*'eh~Ily exan;tined the complete~.,~PJ1U.c~~io~iQ:'d?~~ ~J~e15YC\'5~i~~{t all .
mformatlon hereon IS true and corre ~'ffi'rther certify that any ~nd{l}1)Wof\I&-e'eJ:'form~!!(sh~ty,e5donfJ{lJaCCOrdance With '
the Ordinances of the City of Spri {(ie. :(t8re laws of the State:>?l\0';~t\.Q;1>~fai'g\J)g~~~~l"1bi-K ~~scriJje~\h'Crein. I further
certify that only contractors a ~~ho are in compIianc~ 'YitJi~(,)RS\lO;p:o's5fW.iU tie usetl%~ tbisrp}'Jj~c't-:)~ further agree
rUO~ .:.,~v ~()\\~ ~\O\ '\AI". CV""' 'roe"- .'~~\J'''''''
to ensure that all required i."W,,~ :-,,~~'" requested at the proper\fi~C:;Ctliateac:.fi)ad(Jf>~~s~~~el\..~ati~e f~~g1~tlie street, and that
the approved set of plans~~iC~~ will remain on the site at aIPi~~a'.?in\~'Conq~\!.l;tion~(\ U\\\\\i ~tlctlcl'
. sY?- ~<<:- ~ \'(\ 9\) .~o \'{\e Ce O~e~O -'O?>~-?:-
("~. _"'~ _ \::,~ (). {::> ~. 00 \\\(\~ LA(\'(\e. _ .....~r;:J0
'\. \:- ~,<,' ~)l."h\ \' ().~ C'<' __Po\' - :\ \'"
Owner or CGnfr~mTK~"5t~...re0 ' \}"Wate' Ce'(\\e '
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~ ~~ CO\;)
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Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00093
ELE2003-00093
ELE2003-00093
ELE2003-00093
Payments:
Type of Payment
Check
Paid By
Receipt #: 1200200000000000912
Date: 03/31/2003
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Received By
Check Number Confirm No
LH MORRIS ELECTRIC INC
djb
Page I of I
3/31/2003
lO:50:21AM ,
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
63.00
18.00
8.10
5.67
Line Item Total:
$94.77
How Received
Amount Paid
In Person
94.77
$94.77
Payment Total:
I
...
cReccipt.rpt