HomeMy WebLinkAboutPermit Electrical 2003-6-19
ELECTRICAL PERMIT APPLICATION
City Job Number El-e.:loo?:>-OOI0+ Date
LOCATION OF INSTALLATION
1.
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . Ir..MYb~54-t1.1~~8~ submitted h~s the following
zoning, and does not require specllic land use
approval (,.:t) (2,.
lo -1 q -~ Zoning Ip - a-. 0 -- ~
COlllPLETE pilE SCHEDULE BELOW d tJ
3. Al.ltnonzed Signature 1 )
12.. Il\ '"]; S i-
\E,Q(D~~ST\\No6S CD
JOB DESCRIPTION
CSt-LV I c..t el~cL" ?~{S t. - u~
Permits are non-transferable and expire if work is not
started within 180 days of issuance or if work is
Suspended for 180 days.
CONTRACTOR INSTALLATION ONLY
2.
Electrical Contractor ~u~,tl ~lo
Address -p. () tSG--I- (.,91
City W~I-kL~ Phone ~-Z)l.q
Supervisor License Number t(l'l.. I ~
Expiration Date J(l I O~
Constr. ContI'. Number t --:Sle II ~ {r
Expiration Date f (r I O-~
A. New Residential- Single or Multi-Family per dwelling unit.
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19.00
$50.00
Services or Feeders - Installation, Alterations or Relocation:
B.
200 Amps or less \
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
RecOlmect Only
C. Temporary Services or Feeders,
Installation, Alteration or Relocation
C, 3. CP
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
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
Signature of Supervising Electrician
d 2., New Alteration or Extension Per Panel
,(,{) \JJJl.)\.) \AAAJ....J... } NOTICE' One Circuit $ 43.00
, "i2 '-" I~;S PERMITfi;</1JV\d4itional Circuit or with
Owners Name QAA. \)\&~u.6 It..o~f.ttlj]~~RIZED et;TXlt~df4:etlW!ffftl}\t" $ 3.00
3t]fwMENC IVUfR TJ..//C' . I nfWnDv. " .
Address I G I q -r -;" ANY 1 Of), Ell:{JR~~"Aena'JIIioI1f~'r~I~elill" not mcluded) -Each InstallatIOn
: . '~v DAY PFR BANDONED NOr
City clJf-{~ Phone 7ZG,-&~y) Pu!JtJbrin'igation FOR $50.00
""
Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited Energy/Residential $ 25.00
The installation js ~eir~g p?-ade ~n prope~ I o~n Limited Energy/Commercial $ 45.00
which is not int~~t~~ ~1J!~Iy'~~QY~~ lequlres you to
f, O~I?W ~UlescadoPteThosd by the 01 regon Utti~iJl M"urn Electric Permit Ins,pection Fee is $45.00 + Surcharges
Owners Sig~hcatlon enter. e ru es are se :6W.
in OAR 952.Q01.Q010throughOAR952-;p'01-SUBTOTAL OF ABOVE (()~. @o
0090. You may obtain, copie~ of the rules bY7% State Surcharge L./-. '-t I
calling me cemer. \NOle: l~e tel~~h~e 10% Administrative Fee { /I, ?-; (J
. Inspection Re@MJlb~W1~ Oregon Utility Notification TOTAL
Center is 1-800-332-2344).
Shared Drive(T: )/Building FOlllls/Electrical PCllllit Application 1.03,doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2003-00539
COM2003-00539
COM2003-00539
COM2003-00539
ELE2003-00154
ELE2003-00 154
ELE2003-00 154
, yo. 'vments:
Type of Payment
Check
~
Receipt #: 2200200000000001090
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 7% State Surcharge
+ 10% Administrative Fee
Perm Serv/Fdr 200 amps or less
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
BURRELL BROS. ELECTRIC
Received By
ddk
Check Number
Batch Number Authorization Number
City of Springfield OffiCial Receipt
Development Services Department
Public Works Department
Date: 06/19/2003 3:21:07PM
Amount Paid
43.00
15,00
4.06
5.80
63.00
6.30
4.41
$141.57
Item Total:
How Received
In Person
Payment Total:
Amount Paid
$141.57
$141.57
...'.
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:
ELE2003-00154
6/19/2003
6/19/2003
12/19/2003
l()' I,,'u'en('i, :-:,"', I c:~;...\ll ~,~:" ."..
^.rT E I\!1 ~.' "" 1 -,'"
f"\' t rl b' V -t\'1"" Or8ljO!\ v <I,: ,y
.1_._,."rln.np "t _ ...
PROJECT DESCRIPTION: Service Riser - Raise up
, . enter I rlLI::,t:; ,~II'J~ -- - . ,
Notification e ~ @~~P,t;l~gti~Jt!\R 9S2-0;~ '
in OAR 952-fr~E,_<?F:'::VO~~s o~ Mev,eJ\as l.._
0090 You rnayTqr'PE10F%'SE:, h . Residential
., (Note'l e '(ei.;.il-l""'''-
calling the center. on Utility N01;',:cation
'. .._hodrw the Oreq ..
11-"-- . .A ",An f.l'.).'J .-~ ";,.,.\",,-,;.
ELECTRUe1\.tRr€ONTRXCTOR:'
BURRELL BROS ENTERPRISES INC 541-747.2724
40159 BOOTH KELLY ROAD
SPRINGFIELD OR 97478
CCB # 136446 Expiration Date: 08/20/2003
SITE ADDRESS: 1214 I ST
ASSESSOR'S PARCEL NO.: 1703351100800
OWNER/APPLICANT:
KOEKKOEK JOHN B
1214 I st
SPRINGFIELD OR 97477
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
6.30
4.41
63.00
06/19/2003
06/19/2003
06/19/2003
2200200000000001090
2200200000000001090
2200200000000001090
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same
working day, inspections requested after 7:00 a.m. will be made the following working day.
Reauired Insoections:
1 Electric Service: Approval required prior to utility comp~p~ing servicl;'l EXPIRE IF THE WORK ,
Is PERMIT SHAL n I
By Signature, I state and agree, that I have carefully examined ffil:1~ ijlp~[:RiQQ:\a~l(P~e~1d~~ilY that all
information hereon is true and correct, and I further certify th a ~AY.1 D"U~ f5rf.ffi'W;~IDmiD[i)i&\Ihe in accordance with
the Ordinances of the City of Springfield and the laws of the s&lJ ii~ . .. to the work described herein. I further
certify that ooly eootracto... and employe" who are in eomplia~'(,J&1O !~~ _II he n"d on this proj<<t. I fnrther agree
to ensure that all required inspections are requested 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
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