HomeMy WebLinkAboutPermit Electrical 2003-2-24
,
,:~. 06 . CITY dF (_.,.bNG~iELD, OREGON ' 0' '.", ,
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
City Job Number ~ZOC <, .....cx)Olf 7 Date 0 Z. - ( J( - 0 3,
B. Ser:..wcrs or Feeders - Installation, Alterations or Relocation:
~~'~
~# . ~
",,~~~~Ampsorlegs I $63,00 6,j
1>'" ~,~
",~0 06' 20 I A s to 400 Amps $ 75,00
1:>" ,,~
.~,,~.,\,,0 4 Am 0600 Amps $125.00
~,6\0~~0\ ,"'., , ~ 6 mp, 01000 Amps $163,00
''''~ ~ ~
Phone ,'0">' ^ 1>0 ve OO>AmpslVohs $375,00
\v "" " , r.,\- "'" . ^'
<,,,,0, ~, , ^"" conl1ect~nlyo\' $ 50,00
~" "'" <,,"''''11 0.,->>" 0" e" R)'\'
.. ~,o 1,.0 lI. ,0 ,.\ ~e ~e~_ e c:; ,<)'(,1 .:-0'> '
. Supervisor License Number I {/ ....{\~\.v ~\'&~\0~i\~<>I!JP~~I?':)~!;'c)CCS or Feeders
J i'l <.>,,\0 - ",01>"''' ,e~O o'Q":":'l.~>Sl 'lC>.O~;s-0 ~ ~0",0 0'"
A:, ",,0" ,""~ ",e ,,(.....o.lnstlillati~n, Alieration or Rclocation
1/ ['" ,')" ," ".:v'. ~- ,er .~\V-
~\\:",'l>v ^,0~' ,~"200~~~1P.s$r,leF~
,,'<' ~'u G0" R)~ ,^v ,<>.' '.~' ~~'
..\ ,. ~ ^ "V :I.~20.!\.~mR~:tofOO,j\mps $ 69,00
, ~O' ~v' ~v O'Q l.'\ "'.n '),"
,O~ ,(,'0' :;;,'!: 'l>":" :I.,,401~n~~0~000 Amps $100,00
,,,~~.Q..9J ,\~ (,0<:' r;;~e '6-0(\0' A 1000 V I "B" b
\_ Of" '"'v 'V\.0 I'> ,=,ver( mps or 0 ts see a Qve.
, ~. ~"", '\,. ,. '
'oS' R)<?l~' ~oS'~ 'O~ D,~~Branch Circuits
(,1 (,'1> :oe~ e~''''
,::,~ C. New Altcration or Extension Per Pancl R-~
<:' One Circuit ,~. ~'$i~o
Each Additional Circuit or with \'(~:\ \~ ~ I 2.....
Service or Feeder Penn it ~\\l.~ :.c.~~~ '(~~,OO
E. '~1isc~ilaq<:~us (Set\\\tl.\.,\~~'t~~~~~ed) ":Each '~nstall~tion
~\~~~~'\ -;)~~~~ '!o ~<OY" .. ..' .
pum~~ ~~rg~ ~\) \)\l. '\ ~\)\), $ 50,00
Sign/6\ft~-& \ifJ:..\)~ ~~~ $ 50,00
Limited 'E{;e,' ~ddi:iial $ 25,00
Limited En<y:.~~ommercial $ 45,00
Minimum Electric Permit Inspection Fce is $45.00 + Surch~lrges
I. LOCATION OF INSTALLA110N
43>2. '1 h-a-S"1-1-ll/l.
LEGAL DESCRIPTION
J$DloSZ.1
C) I bO 0
JOB DESCRIPTION
S l-\ (? (? /ffl' e;L i Lf c., ~d,:s
Permits are non-transferable ahd expi~e if work is
not started \\'ithin 180 days of issuance or if work is
Suspended for 180 days.
2,
CONTRACTOR INSTALLATION ONLY
Electrical Contractor
Address
City
Expiration Date
Constr. Contr. Number
Expiration Date
Signature of Supervising Electrician
Owners Name ~,,:>s. \~'(:;1c;.c-4
Address Lf3l.L( ~-::,ru!A-
S (? ~\\ Phone 71..('(- ~z.
City
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
3. COMPLETE FEE SCHEDULE BELOW
A, New Residential- Singlc or Multi-Family per dwdling unit.
Service Included
1000 sq, ft. or less
Each additional 500 sq, ft. or
ponion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19,00
$50,00
$ 50,00
Owners ignature: /~ 4. SUBTOTAL OF ABOVE 7~
!;) 7% State Surcharge .-z.~
- ':>
.v- 10% Administrative Fee 750
Inspection Request: 726-3769 TOTAL '1',7'7 S-
Shared Drivc(T:)/Building Fonns/Ek'Clrical Pcmlit Applicatiolll-03.doc
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City of Springfield
Electrical Permit Attachm,ent
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:
ELE2003-00047
2/18/2003
2/18/2003
8/18/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
4324 FORSYTHIA ST
1802052101600
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION: Sub panel and 4 circuits
OWNER! APPLICANT:
RUSS HEGGEN
4324 FORSYTHIA ST
SPRINGFIELD OR 97478
541-744-5662
ELECTRICAL CONTRACfOR:
RUSS HEGGEN 541-744-5662
4324 FORSYTHIA ST
SPRINGFIELD OR 97478
CCB # Expiration Date:
.\
/("
Descrintion Amount Paid, ~\S~\:)'\ Date Paid Receint Number
+ 10% Administrative Fee 7,5% '\~~ ,S ~ 02/18/2003 1200200000000000716
+ 7% State Surcharge m ~~~ <"0. ~\S 02/18/2003 1200200000000000716
Add. Alter. Extend Circ Ea Add \.'\l:2~l>9~~ ~\.v 02118/2003 1200200000000000716
Penn ServlFdr 200 amps or less ~-v..."t\..~'?- ~~\:)\S, 02/18/2003 1200200000000000716
To Request an inspecji'/.f~n~~~"L~~.at 726-3769, All inspections requested before 7:00 am. will be made the same working day,
inspections reques~,!'!;~S~~~~~ ille following working day. o\) \?
-<.~ 1.......\S ri'>-\J t-l ~ ",<eS 'I . "\\1\'1 .
,?-'V' ~'v \)' :-I'll""" 0"- \0'"
Reouired Insoections~, ....rot:::; er:};O~\'(): \,\\eOI0~\ese~,()()"
. .~, ~O\ 0'0'1 \)\eS a 9'0"- '0)
1 Rough Electric: Pl;ior to Cover ~\\o . oO~\e OSe \ O!>-'<' \)\eS
2 Electric Service: Approval required prior to utilitfcol)lP..lfuY'energii;rg.ser::Vi~-r. O~ \,\\e \,o~e
r' NIV C0'''' ,\:i"" 'eS \e~'" ~
3 Final Electric: When all electrical work is campIer., "'\o~ ",.()() ,~cO~\ ,,,,e \e' "'\C'<>\\O
. ." c'<>" (Iv ''3.\'' e' ", ~\O\\'
"o\\'\ ~ rb~' ,,0'0' ''!oIO\!' ....111 \~ ,
~~ Signa~ureh' I state. and agrede, that IthaVedcIafrefillh'~?: el'mti:?~tIi~ \the~~~P-dJetIeI~o~!,p.k)~~~",~p.t8ndd dhoaIhIeberebdY ce~ify thatdaall
IOlormahon ereon IS true an corree, an urt er c~... A) ",3\..\any a"-'~ ~wo~....;pell0rme s one m accor nee
with the Ordinances of the City of Springfield and t~)lit.'t$\"Ofth~($fa~ o~ C;>r.~bn pertaining to the work descrihed herein, I
further certifY that only contractors and employees WhO(\'8'~iil?-~o~Pllah'ce with ORS 701.055 will he used on this project I
further agree to ensure that all required inspections are requeste'lt at the proper time, that each address is readable from the
street, and that the approved set of plans, if applicable, will remain on the site at all times during construction,
Owner or Contractors Signature
Date
I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00047
ELE2003-00047
ELE2003-00047
ELE2003-00047
Payments:
TWe of Payment
CreditCard
Paid By
Receipt #: 1200200000000000716
Date: 02/18/2003
Description
Penn ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Received By
Cbeck Number Confirm No
RUSS HEGGEN
000002
djb
018643
Page 1 ofl
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2/18/2003 'i>
12:03:5IPM' .
~,
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
63.00
12.00
7.50
5.25
Line Item Total:
$87.75
How Received
Amount Paid
In Person
.
Payment Total:
87.75
$87,75
cReccipt.rpt