HomeMy WebLinkAboutPermit Electrical 2003-2-24
02/12/03 WED 15:33
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bmitted has the following
ujre specific land use
225 UnH STREET . SPRINGFIELD, OR 97477 . PH:(S41)726-3753 .ap1lOO~541)726-3689 C-e.-.
ELEC'l'RlCAL PERMIT APPLICATION Zoning
City Job Number 6LeZoo'3 -D003( Date a./r8/D3 Date 0< - al!- /)3
".,:':', . ..... AuthO~!Z,~P SignatuE~ ~~..
3.COll'lPLETE:FEESCHEl)t!lJiBEWW< .
."..,..........." .'..' ... ;..." . On.
1. LOCATIONOFINSTAL,i'47iQJV: .'
1-/1<1 ," rnt11i~ ;i,lli'J.;
LEGAL DESCRlP'UON
1'60 S 02.:Z...0
c> Z 866
JOB DESCRIPTION
fUl'Y'.oJJ..-t - 2. ('WC~1s
Permits are non,lransferable and cxpire if work is
not started within 180 days of issuance or if work is
SuspeDded for 180 days.
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.;CONI'liAcrOR.INSTALriiioNONL1.-.....
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Address
E AAe VJ.e.,
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1'20 mcrn ro e:...
e1edvlCJ
Electrical Contractor
City
Eu.t1~
Phone 3'14--35& J
<--J
Expiration Date
-~. ~_M~ A. 'r
Owners Name ~<-~ 5~f"
PO C> (; t< I () { 2. ('
Eu.&t':7'\K":' Phone
Address
City
OWNER LNST ALJ,A nON
The in.~ta11ation is being made on property r own which
is not intended for sale, lease OT rent.
A..J'l~;;.'Il~i...,~~~I?Sii1gle:OrNl~!hFain:il~pei- tl~~!"ljin~uni!:i ..
Service lnduded
1000 .q. It. or less
Each additional 500 sq. fl. or
portion thereof
Each Manufact'd Home or
Modular Dwellins Sesviee Of
Feeder
$106.00
$ 19.00
$50.00
B. ::.:.:~~~~:':.~'~:~:f~d,~;~;~;.~~t~~:j4~~~;:Ai"('~~'~;~~~4.~i.~~,~~:~~~~~::,~:,:"
..,.....,'.'......:.'. '. .,
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
.M.inlmum Electric Permit Inspection Fee is $45.00 + Surcharges
200 Amps OT less
201 Amps 10 400 Amp.
401 AffiPS6'O 600~s
601 Amps t ~ s
Ove~~~~ ~~
Rts/{,i'l ri.~\S
\.~ '?:> ~ ~\.'V , . .... . ......
SupervISor LIcense Number I oqz,s CO~~~~~au Sen'lces 'or Feeders.",'" ......... ......:...... ... ",' ,.':..: '"
. N~' ~'\ ~~'V '?:> ~
10/01/ 0 3 _~'\~~\.~\\.-\.\) \)'?l'li~~ation, Alteration or Relocation
"..~ ~\S r;,,\.\) ~ Amps or less $ 50.00
Constr. Contr. Number Cc..6 qO'2.0{Jl\,~ ~~~\.~\) \)~ 201 Amps to 400 NllPS $ 69.00
3'1/ "\St-I,,\'ij 401 Amps to 600 Amps $100.00
~~~ ~o7 ~ ~n
Sib~laluTe ofSupel";ising E1ec~ci3n D. ~~2Zfti;:~%J::O;;IS~;~!t~~::."". .
New A1tcratio'Oor.cE~le.Gi'\Jn J',er ~Mell\l
One Cit~llil\eg 6\)'1" ~~~\0~{>o.~ 9<j~es \)')$ 43.00 If(j.OD
Eaeh'Wddillofl~r-em:3;(OftWitli. .X\a', O~e ." 00
. \..... C' .()...... (" .,nv~ Ol\ \. I".~ '$ 300 <oJ '
,:\'\Servire'<lf Feei:ler Remllt . as ",\:J ~o .
r ~\" GIO" l:)'\\:;' O~\ a\"" .~\C",.
\<'~\\O,' _\\~)~ I)\)'\"~. ",?:it$) G" ..,~.~~ !;~~.,('.!\5., '". . ,
E'~~,~'!,$~(S~Cifclitl~i>no!-@Cl"de") -Eudi 'JnstaUa'tion
~O" ~ ",,-, , :\0'; . ''I.eV' ~\)" '''[6'''' "., '
n\>l -JOU \\ r:a~ a9P ".'2,7.:
W Pump or irmf'ation 0\ f0()';:> $ ;000
('\C'\~'V .\(\()." 0 ,'n.J .4. ..CO ~ .
'-Si.-10utlint.L!'"htinn , $ 50.00
5~_ _"'0" 1:IO'\IO,.D
T.imjtea.'EnefO~y'iResidential $ 25.00
,\~ b
Limited Energy/Commercial $ 45.00
Owners Signature:
Tn.pection Requesl; 726-3769
4.~p~~?:t-M"qf~vE:" "".;:,.,
7% State Surcharge
10% Administrative Fee
TOTAL
'-liP ,00
3 . 2.. Z-
'-I. (g 0
58 . 8' '2..--
Sb..,,'Cd Drivc(,T:)!Buildin~ FonnyElcetrical Pmnit Application l-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:
ELE2003-00031
2/12/2003
2/12/2003
8/12/2003
SITE ADDRESS: 4791 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1803022002800
Eugene
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Add 2 circuits
OWNER! APPLICANT:
DUCK STOP MARKET
PO BOX 10m
EUGENE OR 97403
ELECTRICAL CONTRACTOR:
EUGENE ELECTRIC SERVICE INC 541-344.3561
120 MONROE ST
EUGENE OR 97402
CCB # 90200 Expiration Date: 03/17/2003
Descriotion Amount Paid Date Paid l) \0 Receiot Number
",,\0 .,,,
+ 10% Administrative Fee 4.60 02/1212003 eo.l)\~e ~ U\\\~~QQ200000000000469
+ 7% State Surcharge 3.22 02/12/200~'l'l~ O~eQ,O se'2200200000000000469
Add. Alter. Extend Cire 43.00 ,~2N~t2qq~~ \~e ~eS 0-~e 9S2f02?9P000000000469
Add. Alter. Extend Cire Ea Add 3.00 -<\Ot'02112(20030se ~l) O{>.~ ~2200200000000000469
....w., .-nO,", -<\'\ _,,'n ~",p, V' .....0-
To Request an inspection call the 24 hour recording at 726-3769:' AU;msp\~~i'&~~~steJ~Wo;;\-rO~~a';n,('$ill'l,;;:mrde the same working day,
.. led aft 00 '11 b ad th 'II . ,,,\\Vk. '\!i'~' - ",,\-vv .~c.v~ \~b ,- 'i..\\\''-
mspectlons reques er 7: a.m. WI em e e ,0 oWlUgwor,,!,Qguay. J;)" '!O\'3-\ ~'O\e'. ." ~O
~O~ ..",9'5t; <<\0-':1 0 _.,,~.~~ _ \\\\\\"'~",tl.tl.l'
Reauired Insoections: \~~9\J ;\~ \~~~~~~ C:~~~\J.'O'5e-- ~
1 Rough Electric: Prior to Cover C. l)~'Oe~ ce'(\\e~ \
2 Final Electric: When all electrical work is complete. '(\
By Signatnre, I state and agree, that I have carefnlly examined the completed application and do hereby certify that all
information hereon is trne and correct, and I further certity 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
fnrthercertity that only contractors and employees who are in compliance with ORS 701.055 will be nsed on this project I
fnrther agree to ensure that all required inspections are requested at the proper time, that each~~dress "' readable from the
street, and that the approved set of plans, if applicable, will remain on the site at all ~'el\'l\r.lfufnstrnction.
't.'/..?\rr..'t. \ NlI\ IS ~
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Owner or Contractors Signature ~v\';; ?'t.rr..NI\\ \l~w-j'ill \ "~\)()~\::.V \ ~.
\\'\ :\\\()rr..11't.\) ()rr.. \S r>,'O
r>,\.\ NI't.~C't.\) 't.rr..\()\)'
CONI \~\) \)r>,i ?
r>,~i
I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00031
ELE2003-00031
ELE2003-00031
ELE2003-00031
Payments:
TWe of Payment
Check
Paid By
Description
Add, Alter, Extend Cire
Receipt #: 2200200000000000469
Date: 02/1212003
Add, Alter, Extend Cire Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
EUGENE ELECTRIC
Received By
Check Number CoofirmNo
djb
Page I of!
2/12/2003
3:04:34PMi
City of Springfield'
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
43.00
3.00
4.60
3.22
Line Item Total:
$53.82
How Received
Amount Paid
In Person
53.82
$53.82
.
Payment Total:
cReceipt.rpt