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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 '" "", :JJ . \',~,\ . ",'.J) ~..\"\,, " O C" \\,) ~ \\", , ne Ircmt "'\'}.'. ",~\"", :,:::~ ' a~ 'r\~p ^~\. ' \~; /t,,\'1-;~~) ,,~,;,,; I~,'l~'v \~.~ a" I" 1~;;' .-?~/)J{'j ,,~ Ea cb;,,*acliiztP~l WrfA.{rt lOi*ltI~/SeNice _ ,u.... A\'~"--4.;{~\r' tf>\:~~"- \,\').\>, 1-.J;, ~ }\,orJ.:~)~~~ti'Mt ,~\' j '" .\,,\\-) , ,,,,(';,.' $ ,),00 \ \ \'- ,..'\~ " '" .,~~~] n\, \:' ",'t\'^. n\' >'\..~ ~\:;.;"U >.. ,;n\'\J.. /, - w . \.~*)\{ O\..~\)~ Y'" \\.:A..,... ."J...~; '\.i:.'" ..+,\\,",,\..7- ,,4' !'-r;(S;-,> '\E.~ 1NrlS~jfil:nc..Gtt;,'1.{Se~'l{<\'~li ~i:t)l1tluded) \\0":" . ,,,\\ ,Ti.t' 'l"~' .t"l"'\'~' ~:7>,.' . \~~' ~n\. ".~':>v~, pM'ac,: .L~~~a, 1i;l\1'\Ut" \~\\~~ () l\.,ff'i1' '~\\V ,"Y'p. "', \), .' \3. \, ),. f):.r "WI" ,'\":;..,. V~~lok1;~ga~^~~\..n(~" \ t \~'\( . "\.\,, \ ".1"'-' ."r"i" ,("^,,ofo'!l. >" h.fu" (2,,;;, . \-,,' ',")::'n{l?.~t Il~,,,'1.; e.1<Tw.~g \'0~\)9J\~' '~'~\'~~~'~ttd~1~gy1R6s ~J ,.'(j.'" \! ~',J ~~ 'J ,:\~1l1J.1~,d1ergy/Comm ~\);.~'\ ,\ l~./ 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 ~\i, .'.-~\ \1','\ ,.',' ~'V , ~ ".'.,",',Jo.;, ~' "'\;.' r':"'\)\' ,CI'.... ,C '. ,~v (\'~\ vJ _, 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\(rlyl'(7~ ~ \\/11\.4&- ~ d-~('o'" Address Yl'-l I - d () Y / S'S&-~I~- Ph one <i<;-g:<:;q City OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: ltems Cost SUl~l $106.00 $ 19,00 $ :;0,00 cl $ 63,00 \~ - $ 75.00 $125,00 $163.00 $375,00 $ 50.00 $50,00 $69.00 $100,00 $43.00 $50.00 $50,00 $25,00 $45,00 Minimum Electric Permit Inspection Fee is 545.00 + Surcharges 4. SUBTOTAL OF ABOVE if;r!.o State Surcharge \OJ'W'~AdministratiYC Fee TOTAL t ~ 73d- ~;;.~ ~ I:~ftl \4Y],4J.. , City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00015 1/21/2003 1/21/2003 7/21/2003 SITE ADDRESS: 4630 UNION TER ASSESSOR'S PARCEL NO.: 1702324308500 Springfield TYPE OF WORK: Alteration TYPE OF USE: Residential PROJECT DESCRIPTION: 200 amp service and 100 amp service OWNER! APPLICANT: DA VID TRIPLET 4630 UNION TER SPRINGFIELD OR 97478 ELECTRICAL CONTRACTOR: ABLE ELECTRIC 541-726-6701 1300 ANDERSON LANE SPRINGFIELD OR 97477 CCB # 146374 Expiration Date: 12/01/2003 Owner or Contractors Signature Descriotion Amount Paid Date Paid ~~ Receiot Number + 10% Administrative Fee 12.60 01/21/20Q~ ~\)~\:}"\ 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. o"-'\: ~\~ ,~ O~ ~0 ~O: ~O ~ :-0" 0 ~ ~~ }...0~ .~'l:; . ,,0 ,.0 f'C'd _,~ roO yeJ .:~ .v oitW- ~" ~v. f(I- e. - o~ O~. OO"1?~.t~ ~~' O~~.~ ~ ~. ~~ ~'l:; ~0 ~'" .~v ~0. ~~ rJ ^<v-~ ~0 00 ~~ ~~ ~ " a:~ ~ . ~ ~ . 0<::- ~~ ~ 0" O<::-;b~ ~~O, ~ bf); ~~ 0~O,0~<o~~ ,0 .~v~Oj ~ 0v 0 1\,.' ~~O~ 4.0_n.~ ~~i.~ 'oS' 9()' ~''"'J ~'O ~0 ()~ CJ'l:; ~0 OeJ <::- \;)~ 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