HomeMy WebLinkAboutPermit Electrical 2003-3-5
CITY OF S,- .2.rNGFIELD, OREGON .',:' '0:", ;:.:~'.~,.
as submitted has the following
t require specific land use
i25FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)1t~i~~89 LDIt..
ELECTRICAL PERMIT APPLICATION Date"?- S- - 0 '"
City Job Number .~LC}.DTJ '='.l - ~ Date ,3- 3 - 0:' '-J1t1onzea Signature 9<1~
I. LOCA110N OF INSTALLA110N
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LEGAL DESCRIPTION
11. 0 ~. ~<l . I'!>. DO 10 0
JOB DESCRIPTION
A!J,<..J ~t!.... :t"S.
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.
CONTRACTOR INSTALLATION ONLY
EUGENE ELECTRIC
Electrical Contractor
Address
120 MONROE
EUGENE
h 344-3561
Pone
City
10925
Supervisor License Number
Expiration Date
10/01/03
Constr. Contr. Number
CC890200
Expiration Date
3/17/07
Signature of Supervising Electrician
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Owners Name ~ M~'., ~..uz....j _
Address ?O'l> Ec). - r ...JL,- 1.0""",
U ;
City ~Q~''''''.,( Phone ~- 572-V_
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
3. COMPLETE FEE SCHEDULE BELOW
A. New I{csidential - Single or i\'1ulti-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. fl. or
portion thereof'
Each Manufacf d Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19.00
$50.00
B. Services or Feeders - Installation, Alterations. or Relocation:
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps 10 1000 Amps
Over 1000 AmpslV olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C. Temporary Services 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 Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Pennit
I
$ 43.00
3
$ 3.00
E. Miscellaneous (Service/feeder not included) -Each Installation
Pump or irrigation
Sign/Outline Lighting
Limited EnergylResidential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permitlnspeclion Fee is $45.00 + Surcharges
4. SUBTOTAL OF ABOVE
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S.!...,.
5.Z-l>
JO.'if<l-
.-
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FonnsJElcctrical 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:
ELE2003-00057
3/3/2003
3/3/2003
9/3/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
500 EDGEMONT WAY
1703341300100
Springfield
TYPE OF WORK: Alteration
TYPE OF USE: Residential
PROJECT DESCRIPTION: New Circuits
OWNER! APPLICANT:
DUPRIEST ROBERT W JR & CON:
500 EDGEMONT WAY
SPRINGFIELD OR 97477
ELECTRICAL CONTRACfOR:
EUGENE ELECTRIC SERVICE INC 541-344-3561
120 MONROE ST
EUGENE OR 97402
CCB # 90200 Expiration Date: 03/17/2003
Descrintion
Amount Paid
Date Paid
Receint Number
+ 10% Administrative Fee
+ 7% Slate Surcharge
Add. Alter. Extend Circ
Add. Alter. Extend Circ Ea Add
5.20
3.64
43.00
9.00
03/0312003
03/03/2003
03/03/2003
03/0312003
)200200000000000756
1200200000000000756
1200200000000000756
1200200000000000756
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 am. will be made the same working day,
inspections requested after 7:00 a.Ill. will be made the following working day.
Reouired InsDections:
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
By Signature, I slate and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance
with the Ordinances of the 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 that all required inspections are requested at the proper time, that each address ~ readable from the
street, and that the approved set of plans, if applicable, will remain on the site at all times during construction.
~ ~"- /u~
Q'wner or~cithlCtOrs'Signatureju., "Iv') I dt.{UIlc..b ~I'J;'" ...-
follow rules adopted b:Hhe aragon Utililj
Notification Center. Those rules are set fa,'
in OAR 952-001-0010 th:ough -JAR 952-CC :
0090. You may obtain copies 0'( the rules .:;
calling the center. (Note: the telephone .
number for the Oregon Utility Notificatior.
Center is 1-AOr.-::l1?-::>" '-4).
3-"3-03
Date
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
. Line Hems: .
Job/Journal Number
ELE2003-00057
. ELE2003-00057
ELE2003-00057
ELE2003-00057
Payments:
TWe of Payment
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CreditCard
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Paid By
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Description
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Receipt #: 1200200000000000756
Date: 03/03/2003
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
EUGENE ELECTRIC
Received By
Ikw
000007
Check Number Confirm No
Page I of 1
003209 .
3/3/2003
8:57:42AM
,
City of Springfield
Development Services Department
Public Works Department
Official Rccei pt
.
~
Amount Paid
43.00
9.00
5.20
3.64
Line Item Total:
560.84
How Received
Amount Paid
In Person
Payment Total:
60.84
560.84
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cReceipl.rpt