HomeMy WebLinkAboutPermit Electrical 2003-5-16
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225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX,; ~ J~~9l9f8'iJlct as submlnad has tha fOllowing
, aoes not require spac'fl I
b'LECTRlCAL PERMIT APPLICATION approval I c and Usa
eCityJObNUmber 6..k'""7rY'1] -dOIZ3Date 5/1'1/03 _ Zoning Lbfll-
, 'I Data "'-U.-n3
I I LOCA110NOFINSTALLATION 3 I COMPLETEFEL'sr.mmVLEBELOW )
. . P" 'mmm-<;'gnat'jJ(,-_ 15;./1
2'01 'P/lo.'-.Cf'lH;
LEGAL DESCRIPTION
/7G33l{/L(
09700
JOB DESCRIPTION
S'-PR..tJ ( (' /J-_ U ~k1() A
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. I CONTRACTORINSTALLA110NONLY I
Electrical Contractor 1::. (' ./;;(r A-I,;
Address rJ. o. V3 w 2.. Clf J 3
City ~ (' t/v>..Q..
J
Phone Ion -b.?-Jt.
.supervisor License Number ,i VQ S
Expiration Date /0 !oj! 6 'i
I I
Constr, Contr, Number '7 t') f:r-li-Cf
Expiration Date / .)..../36/1"5 ,/
, /
Signature of Supervising Electrician
~~JJA4/
Owners Name _D 0.# /'" ~tJYL/.Lf:
Address !1 () J f' /IJ )( (J a (j
City s:'jl.A) Phone7<11-;290/
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease Of rent.
Owners Signature:
.
Inspection Request: 726-3769
A, I New Residential- Single or Multi-Family per dwelling IInit,
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
$ 19,00
$106,00
$50.00
B, I Services or Feeders - Jnstallatioll, Alterations or Relocation:
200 Amps or less I $ 63.00
201 Amps to 400 Amps $ 75,00
401 Amps to 600 Amps .. ,~1J5.00
Ire" ,~...
601 Amps to 1000 AmRJo ,aW reClU . _ \ \\~1',~3,00
Overl_1000,P,.IDpsNJlg db" \ne or~. \:l~~' ~,,'$3.75,00
11.\ t:." d nte 1 ..
Reconnect&n.1Y). 0" ,hose ru\e~ "':':- ~"1.~0l00
i~\\O:.~\~n G~n\~:. f-~~..nl,a"~~" ";.~\O~ b
C!,\UWJl\llo.rll"Y-ServlrJs"~~,lie~erS"' " '.,,' .",C:
1(\ v' ,. 'loul'f\a'/ U ,- 'No\e: \\'\~ """'lica\iO(\
1^"tOI!:\I' , AIt _-ti"P,f. 'R I ..'".... NO\I
uSIa ahop-' era on or e o~uon )
r.all\l''::I ", Qregu" - 344.
200 Aml1s,orjl{,ss \ne. . . 000-332-2 $ 50.00
OU\.'....- + .~f \S ,-0
20 I Amps to 400fAmps $ 69,00
40 I Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
D. I Branch Circuits
New Alteration or Extension Per Panel
Ooe Cir"Jliy.~. . t. Ie il-\fSwr.ool<.
Eac1\"NiQiiIt5~Gi'f'1i\ifl;Wtli~P'\E\<.MIi IS. ~01
Servi~~\ilf,JPe~deJI'P,e.I\l1i~OI:\<. 1\1\5 ~oWo
t! ,,.uf"\p,\ItU UI _ ~ ,clINOONtU
E.IMis,~fI\~!!~lil~~qS~~,~H~ oJ "[ not included) -Each lnstollotion I
o..\\\'i ,B\.)
Pump 6f Irrigation $ 50.00
Sign/Outline Lighting $ 50.00
Limited EnergyfResidential $ 25.00
Limited EnergylCommercial $ 45,00
Minimum Electric Permit Inspection Fce is $45.00 + Surcharges
4. LSUBTOTAL OF ABOVE b.3-
y'-t/
670
7 '!,E
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)lBuilding FonnslElectrical Permit Application 1-Q3.doc
.
.
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:
ELE2003-00123
5/14/2003
5/1412003
11/1412003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
801 PRESCOTT LN
1703341409700
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
PROJECT DESCRIPTION:
Service change
OWNER! APPLICANT:
MALONEY DOYLE D
801 PRESCOTI ST
SPRINGFIELD OR 97477
ELECTRICAL CONTRACTOR:
KS ELECTRIC 541-686-6236
PO BOX 24933
EUGENE OR 97440
CCB # 70889 Expiration Date: 1213012004
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee
+ 7% State Surcharge
Perm ServIFdr 200 amps or less
6.30
4.41
63.00
05/1412003
05/1412003
05/1412003
1200200000000001187
1200200000000001187
1200200000000001187
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.
Reouired Insoections: '1.0
1 Electric Service: Approval r%'!,u\fe~'!1ii~\>t\l utility company energizing service.
By Signature, I state and agre!';':ii?~~,llti~verc'a'f.,fuily' examined the completed application and do hereby certify that all
N~ r\\....- .,0- .0..... ...,'"'
information hereon is true;and correct}anda'further certify that any and all work performed shall be done In accordance with
-\' "ll\- ,o"''''c''' ':\""- ......".
the Ordinances oft~'b~i~~-S~ S!!,:ine!!~d ~j(tli~,~w~f the State of Oregon pertaining to the )Vor" I.l~~m>ed herein. I furthcr
certify tha.. t on~y',c_o~t,!;,~~t~~,!n~,,~~p~o?;(es.,~~~~~~in compliance with ORS 701.055 will b\~~lJI'iln'iJhl~TOject. I further agree
to ensure t~!'all rsqulre.d insl'.ecti~\ls'ar~;requssted at the proper time, that each ad.ll!"~r"\\~~Je'fr'llm the street, and that
the apP'rQved~e{of. p'1~ii'S{jf.\~p'plic~hle%iII\~e'lnain on the site at all times dur~~~s~~iVli. ~\) '{(J'i\
t~~~~c~~~~~~~~~~~~:~~~\)~~\~~' ~~~~~~~'n~~~~\~ ~~~~\)\)~
Owner,oPCoill1ilClors SIgnature")' a.\)\l \ ,\"<y.,\)"?' ~\IO* 1J',;,p.\f',\).
,V' ,-~. X\'" V" ~\)\ x.\"VC lil,-,,\\J
,~ R)C1>\)' ~,~~ ,o\~ ,i,f:;) c,\)~\f\ ,,\)~
(:l c'l> :.oe\ Ce~~ ~\'{ ,\'0\.1
~V>~ \>.\..
Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department ·
Public Works Department'
Official Receipt;
Receipt #: 1200200000000001187
Date: 05/14/2003
Job/Journal Number
ELE2003-00 123
ELE2003-00 123
ELE2003-00123
Description
Perm ServlFdr 200 amps or less
+ 10% Administrative Fee
+ 7% State Surcharge
Amount Paid
Item Total:
63,00
6.30
4.41
$73.71
Payments:
Type of Payment
Check
Paid 8y
KS ELECTRIC
Received By
djb
(;heck Number L'onJirm No
How keceived
In Person
Payment Total:
Amount Paid
73.71
$73.71
.
.
511412003
9:59:37AM
Page I of I
cReceipt.rpt