HomeMy WebLinkAboutPermit Electrical 2003-5-16
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- CITY OF S\_~.ilNGFIELD, OREGON l)
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r t as submitted has the tollo .
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAXi:p(54UI.26_~'I.'89not require specific land us;Jng
ELECTRICAL PERMIT APPLICATION ZOning ~I"l.
City Job Number eLEd003- OOI;;;l~te s-N-03 Oate_ '-1"-03
I. LOCATION OF INSTALLA110N 3. COMPLETE FEA1P~"Ci1'kfj'i'fltg'Bffl,~~" "1'<0
2,~-;)tf T)o~t/lc:. DYtV't
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JOB DESCRIPTION
~~ ~\V'~1\ Yl0clcLlo
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
A. New ~esidential- Single or i\1ulti-Family per dwelling unit.
Service Included
1000 sq. ft. or less .
Each additional 500 sq. ft. or
portion thereof
$106.00
$ 19.00
Each Manufact"d Home or
Modular Dwelling Service or
. F.;e.aerENTION:Url:lYu" ,dill I'"':' ".~- \Ill" ~$50.00
f' ,iow rules adopted by the Oragon Utlltty
CONTRACTOR INSTALLATION ONLY BN fJervices.orrFeeder., =-, Installation', Alterations'or Relocation:
2. t 01UICtlUUlIVOIU\;;I. I....-'~ ......~. _.- - ,
m \ I I (JAR 952-001-001 0 through OAR 952-00
Electrical Contractor u..u( f ~c\-\11 ,Cto. 0 iC>C" 2;b.~tJ~o\'f l~a'y obtain cople!' "I thp ru$,63.00
D -I / ~~I~WP'~g~~1g0,,~~lPJr. (Note: thp teleoh$17.5.00
Address ~ d. ~ I G; "-.\\ e" \..6---v\ Q 40rtu'W\'JJ~f'laP~tj\Jl1I)~egon Utilitv NotificSli25:00
(\ ~ UCf -1~5"c[ 601 Amps@E!PIlQrAml>s900-33?-2'i44). $163.00
City \,'f) &~e Phone !If Over 1000 AmpslVolts $375.00
Reconnect Only $ 50.00
Supervisor License Number 3CJ;;l.:3 S C. Temporary Services or Feeders
Expiration Date ~ f1: orA. Installation, Alteration or Relocation
. 8" 75! 0 6 200 Amps or less $ 50.00
'"' ........--
Constr. Contr. Number ~_'- . ~~:F-' '(,.J;l, 201 Amps to 400 Amps $ 69.00
.~::.-~,,:l.. I NQIP~OC",pst0600Amps $100.00
Expiration Dat~ I - ?-o- 0 3THlSvg@OMA~~&Uo@il(\l~J.fe 'f.~~"~,Q!lK
S. fS" EI .. MITll.""\rD'7~n.JI~Ir.\t.t: R THIS PERMIT IS NOT
19nature 0 upervlsmg ectnc13n tu. rB mlt.. ~u+tUits
9J COMM~CED OR I~ABANDONED FOR
D (\ 1\ tl '\ <1 ^N~ei'i ~AaPf;JH\lioo~ension Per Panel
r ~ /I\.J t....U.J./ \ One Ircult I $ 43.00
. (Each Additional Circuit orwith
~..... ,-\....a Service or Fe'eder Permit
Owners Name k+'\ Iii I\J 't \ l' C!--( ~'f (y.,S&-'f\.
Address 3 '3d.\.1 J)CUI...~S 1,1.
City, ~ r\
Lf3 . cD
$ 3.00
E. Miscellaneous (Service/feeder 110t included) -Each Installation
Phone
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
OWNER INST ALLA nON
The installation is being made on property lawn which
is 110t intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
7% State Surcharge
10% Administrative Fee
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3.1~
Lj.~
r:; 'd., w;;:
Owners Signature:
4. SUBTOTAL OF ABOVE
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building Fonns/Elcctrical Pennit Application ).03.doc
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City of Springfield
Electrical Permit Attachment
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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:
ELE2003-00122
5/14/2003
5/14/2003
11/1412003
SITE ADDRESS: 3324 DOUGLAS DR
ASSESSOR'S PARCEL NO.: 1802062103300
PROJECT DESCRIPTION: Spa circuit and hookup
_ .. ~pr\Qgfj~ld; you .'J
^""'-ENTION:lT1f-P-EJOF'WORK:egonl'i.eil:;ty
~'l ".\...~t:llll
1\ w rules adopThlPE OF USE:. are ~.!:~ii\eritial
to ~. enter. Those rUle5 -00'.
No\illca.t~~~ ~nU)f\1 0 through OAR 9~~~~ h
in \E't'Ec"fIiIGAl1t€0NfiUCTOR;,one
OC~~"IEl1~dTRTC~~!~N~~'~ii;jt~ Not;liC85~17291454
\3~~1!ilRIl!EY{1fANE'~~~ ""0_2344).
<:;OTIAGE,GROVE-OR97424
CCB # 87506--' Expiration Date: 11/2012003
OWNER/APPLICANT:
LARSON BRIAN R & TRACEY L
3324 DOUGLAS DR
SPRINGFIELD OR 97478
Descriotion
Amount Paid
Date Paid
Receint Number
+ 10% Administrative Fee
+ 7% State Surcharge
Add. Alter. Extend Circ
Minimum! Adiustment Electrical
4.50
3.15
43.00
2.00
05/14/2003
05/14/2003
05/14/2003
05/1412003
2200200000000000843
2200200000000000843
2200200000000000843
2200200000000000843
To Request an inspection call the 24 hour recording at726-em~1I inspections requested before 7:00 a.m. will be made the same
working day, inspections requested after 7:00 a.m. will "ffl~~~~~~lf~~\\re~j{jgllW'IF THE WORK
t. .-. 1--.--- ....--- _.,,~ --.,,/'- Ir' f''"~
nv II Vlllil..L..t., ''/ULlL..ll Il1lV I L..11nll) ...., lIVI
Reouired Insoections: COMMENCED OR IS ABANDONED FOR
1 Rough Electric: Prior to Cover ANY 180 DAY PERIOD.
2 Final Electric: When all electrical work is complete.
By Signature, I state and agree, that I have carefully examined the completed application and do bereby certify that all
information hereon is true and correct, and I further certify that any and all work performed sball be done in accordance with
the Ordinances of tbe City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further
certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree
to ensure tbat all required inspections are requested at tbe proper time, tbat each address is readable from the street, and that
tbe approved set of plans, if applicable, will remain on the site at all times during construction.
Owner or Contractors Signature
Date
Page 1 of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00122
ELE2003-00122
ELE2003-00122
ELE2003-00122
Payments:
Type or Payment
CreditCard
5/14/2003
City of SpringfieJd
Development Services Departme~t
Public Works Department.
Official Receipt
Receipt #: 2200200000000000843
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
+ 10% Administrative Fee
+ 7% State Surcharge
Paid 8y
EDWARD N GUIDRY
9:27:03AM
Received By
ddk
Date: 05/14/2003
Amount Paid
Item Total:
43.00
2.00
4.50
3.15
$5Z.65
(;heck Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
000068 000002
52.65
$5Z.65
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