HomeMy WebLinkAboutPermit Electrical 2003-3-13
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753
ELECTRICAL PERMIT APPLICAI10N
City Job Number !::LC;:C:t:..-) 3- 0 () 0 7 / Date
_ ' as submitted has the following
. FAXJll(~I~"a(~"'ot require specific land use
approval
1.
<644
LEGAL DESCRIPTION
~703 /S3C)
JOB DESCRIPTION
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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.
Electrical Contractor
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Address jCic) I,,-,tuc\ \ >J( ~)
City [ _ L~)(Y)~
LIQC I (I:}")
Phone t 'y:) '- ,- ',~,
Supclvisor License Number ~ 1 Cj ()
Expiration Date I (J - I '(I lJ
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Conslr. ContI'. Number
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Expiration Date J':.). i I} - 0 .~
vising Electrician
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Owners Name M OAf'\nq.Q( ---dJ../ (l Ilh CU.A{J
Address ;?5'-< 0 '~f+((~t- ad
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City
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owncrs Signature:
Inspection Request: 726-3769
Zoninr ~
03, ISO '3 3ate :~-(f<; -o~ \
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A. New Residelltial- Single or Multi-Family per dwelling unit. ",
Service Included
1000 sq_ ft. or less
Each additional 500 sq, ft. or
pOl1ion thereof
Each Manufact'd Home or
Modular Dwelling Selvice or
Feeder
$106.00
$ 19.00
$50.00
B. Scnices,or Feeders - Installation, AHenltions orRdocation:
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375,00
$ 50,00
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I n,s;tl'iIla tin'liAi (el'a'fib'ii'o (R'cltl~a tio\rt ,~: '
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D.
$ 50.00
$ 69,00
$100.00
New Alteration or Extension Per Panel
One Circuit I $ 43.00 4- ~ ---
Each Additional Circuit or with 4'-)~
Selvice or Feeder I'cnnit --.~ 'flO~'OO J d'
E. '~1i~~~ii~)ie~us .(ser~'i~~,'$~~~~l~~'~hiliS~~Ii~ti~n
\C~. S\\~\..\.. '\\\\S V '~\) to
~~Q1 b~~\11\)~\)t.~ ~~~\)O~ $ 50,00
Sit~~~~~llll~ \S ~ $ 50.00
Li*~,~1J\~~~~i~\6~\)' $ 25.00
Lim~.j~~mmercial $ 45.00
,~,
Minimum f<Jectric Permit Inspection Fee is $45.00 + Surcharges
4.
s- )~~
'3 #&5
f).. SO
bi~
7'% State Surcharge
10% Administrative fee
TOTAL
Shared Drivc(T:)/Building Fonns/Elcctrical Pcnnil Application I-03,doc
~
City of Spr~ngfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfiel~ Cffegon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00071
3/13/2003
3/13/2003
9/13/2003
SITE ADDRESS: 844 BEL TLINE RD
ASSESSOR'S PARCEL NO.: 1703153000900
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Commercial
PROJECT DESCRIPTION:
Add 5 circuits
OWNER! APPLICANT:
SYCAN B CORP
840 BEL TUNE RD STE #202
SPRINGFIELD OR 97477
ELECTRICAL CONTRACTOR:
BUILDERS ELECTRIC INC 541-485-0922
195 MADISON ST
EUGENE OR 97402
CCB # 4296 Expiration Date: 12/10/2003
Reouired Insoections:
~...-
,Date Paid ~eS '10 .Receipt Number
)J.\\ v" ~
03/13/2003 .. ~ :\e~ :\e~0~220B~~~000000000592
03/l3/?9q~00 \'0: \'(\e 0 s 0.'\~~@J2b~~0!)Q0000592
0,3('J:J'l.209feo. '0'1 5e ,\).W O\>-~-2RQ~000g0000000592
" ~'03113i400\ ~'(\O ~O\}~'(\ 0\ ~2002.Q,Ol>9'O~P0000592
/\ ~ \DS _~P.' _ ~'<\\ . _c, .\P.'O .HO
p.' '(v' C~\"' f.\"\v' :Q\~ ,"v' .<- v""
To Request an inspection call the 24 hour recording at 726-3769. All iri~p-~~tioBS\feq'uestJ~hjefOl;,e 9fooLa:ih~\tiJ.l~b-~~de the same working day,
:\V' ,'O.\,\~ \)\J . ;to.' 0'""'" " p
inspections requested after 7:00 a.m. will be made the following work'ing{oay-,- 9JS'2: n."o\:5 :\ ~ \)\~\"\1 () f>tb.')'
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_ Or .....In\). _ r.e ~~P.~ . 0..'5
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'(\\).f0 Ce
5.50
3.85
43.00
12.00
Descriotion
Amount Paid
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
By Signature, I state and agree, that I have carefully examined the completed application and do hereby cert.if~~t all
information hereon is true and correct, and I further certifY that any and all work performed shall be ~~llil ~dance
with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining_t9J ~r ~~i ed herein. I
further certifY that only contractors and employees who are in compliance ~i.tl! ORS 70~~~1 C!?~~ RD{f.b% project I
further agree to ensure that all required inspections are requested at the~t\bjrer le~~(fJff~~~~'yeadable from the
street, and that the approved set of plans, if applicable, will remain on'\\ne \i~~~ ,tiJ'd"\(JR-ri~W;nstruction.
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Owner or Contractors Signature
I of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00071
ELE2003-00071
ELE2003-00071
ELE2003-00071
Payments:
Type of Payment
Check
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 2200200000000000592
Date: 03/13/2003
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
BUILDERS ELECTRIC
Received By
Check Number Confirm No
djb
Page 1 of 1
3/13/2003
1 :30:39PM...
City of Springfield
Development Services Depa..t...ent
Public Works Department
Official Receipt
Amount Paid
43.00
Line Item Total:
$64.35
How Received
Amount Paid
In Person
64.35
$64.35
Payment Total:
.
12.00
5.50
3.85