HomeMy WebLinkAboutPermit Electrical 2003-1-22
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
fNSPECTION REQUEST: 726-3769
ufFICE: 726-3759
ELE" JCAL PERMIT APPLICATION
City Job Number e-LFcCD3- OOO/.S-
D. Branch Circuits
New Alteration or Extenst~\~P~r Panel
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3. CONWLETEFEESCHEDULEBELOvV
1. J- 0C~TIO~ OF ~~TA.L.1::.A1:,ION
~03c5 .l_lQlnl ~.-P~
A. New Residential-Single or
Multi-Family per dwelling unit.
Senice Included:
LEGAL DESCRIPTION
170'7 3'ZL13
08500
~\{\9
JOB DRSCRIP,TION (~_ 1000 s'i\J1~~t~s
~-12---,~) (d . ~ \(3Q~_ ~\~'1t~€lN1TIonal 500
~,t 0..(-' . '3.'" ",v'Q \\0(:'f9~t or portion
Permits are non-transferable and expire 9 Q\O\eC~o\ \e~u hereof
if work IS not started within 180 days \O,,0~~6 60e5 -. am ome 0
of issuance or if work is suspended forX\e(\\(\g '3., Mo
1-0 0\1'3. {\g 0
180 days, '3.QQ\ 1-0: ,1'
-",>\u\1>
2, CONTRACTOR INSTALLATION O~Ye ~~\;!YCnices or Feeders
. \. 0\\1-06 Installation, Alterations or
Electrical' Contractor j(.401 ~ _ el pC ..\.Vtvt: Relocation:
Address \~f) QM1.i~() LAlt( 200 amps or less
n I 201 amps to 400 amps
City \.. ~ {') Phone' )(Xcr(cl)O 401 amps to 600 amps
/ J CC10C 6Q~\4l111PS to 1000 amps
Supervisor License Number '-t 0 I O......:J \"', 't'\~~rNtlOOO amps/volts
K\~'" ~ \:
I ~!e q.~l?\~~~\?~:~(~ ~~~~ nnect Only
~. ,"... r t:,\~l}porary Senices or Feeders
Constr Contr. Number . 4'~'-:\ ' .~.,; ~\)\)~installation, Alteration or Relocation
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Expiration Date ~ . 'v,__ ....f, \J\ ~\\\v' 200 amps or less
'\,'(\\ \'V~C~\;'\,...-:I 9~\""'" 201 amps to 400 amps
. :0-> '. \~\'v~. \)0 "~I
-VISmQ1~,\~~~ Over 401 to 600 amps
Over 600 amps or 1000 volts see
"B" above
Expiration Date
~turr~
t/l( ~"_
Owners Name QA..\t\(rlyl'(7~
~ \\/11\.4&- ~ d-~('o'"
Address Yl'-l I - d () Y /
S'S&-~I~-
Ph one <i<;-g:<:;q
City
OWNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
ltems Cost SUl~l
$106.00
$ 19,00
$ :;0,00
cl
$ 63,00 \~ -
$ 75.00
$125,00
$163.00
$375,00
$ 50.00
$50,00
$69.00
$100,00
$43.00
$50.00
$50,00
$25,00
$45,00
Minimum Electric Permit Inspection Fee is 545.00 + Surcharges
4. SUBTOTAL OF ABOVE
if;r!.o State Surcharge
\OJ'W'~AdministratiYC Fee
TOTAL
t ~ 73d-
~;;.~
~ I:~ftl
\4Y],4J..
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00015
1/21/2003
1/21/2003
7/21/2003
SITE ADDRESS: 4630 UNION TER
ASSESSOR'S PARCEL NO.: 1702324308500
Springfield
TYPE OF WORK: Alteration
TYPE OF USE: Residential
PROJECT DESCRIPTION:
200 amp service and 100 amp service
OWNER! APPLICANT:
DA VID TRIPLET
4630 UNION TER
SPRINGFIELD OR 97478
ELECTRICAL CONTRACTOR:
ABLE ELECTRIC 541-726-6701
1300 ANDERSON LANE
SPRINGFIELD OR 97477
CCB # 146374 Expiration Date: 12/01/2003
Owner or Contractors Signature
Descriotion Amount Paid Date Paid ~~ Receiot Number
+ 10% Administrative Fee 12.60 01/21/20Q~ ~\)~\:}"\ 1200200000000000580
+ 7% State Surcharge 8.82 01/21~~'3'~ {:) 1200200000000000580
Perm Serv/Fdr 200 amps or less 126.00 Ol..~ ~ G.\:}~ 1200200000000000580
.....t\" 0 ~......~ 'i.
To Request an inspection call the 24 hour recording at 726-37 69. Al~~~~?~~\efore 7:00 am. will be made the same working day,
inspections requested after 7:00 a.ill. will be made the fO~~i.n~~~~c ~~~
...S\"\'\ ,,'V~ {~\) "Q,.\S C'.~.
,..... ~~' ~\,.ov ~ v ~\\j
Reouired Insoections: '\~ ~\'0\) ~~\vx; ~ ~~
1 Electric Service: Approval required prior t~ e,~\~~ny energizing service.
By Signature, I state and agree, that I have carefull~~xamined the completed application and do hereby certify that all
information hereon is true and correct, and I further certity that any and all work perf~~ shall be done in accordance
with the Ordinances of the City of Springfield and the laws ofthe State of Oregon ~~!Q@~d(}t1~e work described herein. I
further certity that only contractors and employees who are in compliance with O~6~~98~ ~tbe used on this project I
further agree to ensure that all required inspections are requested at the propeC..iI\~.~~CP~~ess is readable from the
street, and that the approved set of plans, if applicable, will remain on the siJ.il\'atJij ~jf~~r~g ~h~~uction.
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1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-000 15
ELE2003-000 15
ELE2003-000 15
Payments:
Type of Payment
Check
Paid By
Description
Receipt #: 1200200000000000580
Date: 01/21/2003
Perm Serv/Fdr 200 amps or less
+ 10% Administrative Fee
+ 7% State Surcharge
ABLE ELECTRIC
Received By
Check Number Confirm No
djb
Page 1 of 1
1/21/2003 '
1 :39:39PM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Amount Paid
126.00
12.60
8.82
Line Item Total:
$147.42
How Received
Amount Paid
In Person
147.42
$147.42
Payment Total:
cReceipt.rpt