HomeMy WebLinkAboutPermit Electrical 2003-6-13
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225 FJFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F'" Y1' {".fH.'I.?<ill91s submitted has the following
Hte on<J'oTU'In""1 '''lc land use
ELECTRICAL PERMIT APPliCATION zoning, and does nol requlfe ~~~9' I
City Job Number t3.ezoc3-OD/I-f:> Date ~//3,101 approvalzOnin" c:.-. (l ,
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3. r:;;'C;OMPIilltEfJimSC-':'nuiJiill'1$J:.Lo.l1t" ,,<" '<:1;/.;,;,"7,\ ;,~; 1
it.'." ,,' .'L ,,'-" . "'"'>t~~J~~~~~ri~'-~d -S~;~~~tui~! .,'l.....,,:":,~.I"!',l.'..;'.r.;~',J'~~"'u ':..,1
200 Amps or less / $ 63.00 tJ? J ,DO
20 I Amps to 400 Amps ' $ 75,00
401 Amps to 600 Amps $125,00
_~~Amps to 1000 Amps $163.00
Phone S41-688-6121 ~ ~\()~ 1000 AmpsNolls , $375.00
~ '\'<' :\ \sR~connect Only $ 50.00
Supervisor License Number '::"7 SgS , ~ .~~~:~~~~~\iiUpjif;tiY;&e"ri\.J.se*~€~~ii:s,:!)i;.:;;iI!,:::i,~~Y-:;;:.~ ~~.;;i:,,:,;" ~:&,~
~:. '0'<'-'(' ~~' 'X-~\j
Expiration Date . 1966WQ4~~\- \\~~ \c.,_~'?) Inslallation, A1leration or Relocation
"~\'O '< ~~1..~~\) \)~~~\)\>' 200 Amps or less
Constr, Contr. Number '\ '(Jl;'i.'9:4():-~" .~-l. ~, 201 Amps t0400 Amps
,(,(~~'\'O~ V' 401 Amps to 600 Amps
Expiration Date 10/0r'1.00.
\'
Signature of Supervising Electrici
. ' 4 IU /J NOneWcAlte~ation or Ex~~~~o" Per Panel
, , T.<l,...,..v ( ')/ e IfCUlt . \\,eS' \\,\i\'l $ 43,00
( Each Addition~I'Circuit br with\' , /
/' Setvic~ br'l\eede'i'P6'nnitSe\ 'QO\ f. $ 3,00
Owners Name ("};t.a S-rR-AS(!,A-v-tfJ-l \0\~'U'~'~"O'O'J', ",\eS':'no,S~' l'"
~.. ,..\ 6(fl.Gr...".tfI...'r'.,.!;....~...d~'....:\!"..,.:~"..~~~~r::!.I..\..~.:i';~........""'..~\.,y.;;.....'1.,,"I.J....~. :~~;.'~
Address 3l~ l4. ~ q, ~ ,\ \ \.- r\ \\eS E:(~~~~~J!~9~~~~\~!{W~$![~~H~lj!~}!~:~C;1~~~qt~~~~~j~n~t~l~~.~!~~~
e R. C{ll(6 \0"-'" \,a~ Cu,~.CO'\~ ,. r.,a'9'(;'<> - \e\e\>:" \,a~
City f. ~Af ,. Phone ,~;,\IC'" n,,~.\)\Pum~9nimgati.9ri~e ~\a\'\\C'Oo $ 50.00 .' - J
) " ",",,,;; ,'IV tN')' ,.'."I\~ - -
'n 0"" "a" \\'Sign/0utline Lightillg' n' ^-'. $ 50,00
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OWNER INST ALLA nON , 0090." (Ie;) \r-r.iffiited\Energy/R2sidential $ 25.00
ca\'\ \I~I.\1 ~~ , , ~ .'Qv" ,
The installation is being made on property I own which -,\\)el Lumted Energy/Commerc131 $ 45.00
, , ~,. ~-
IS not lOtended for sale, lease or rent. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
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LEGAL DESCRIPTION
/703'2.700
Zst>
0690..3
JOB DESCRIPTION' I StAt, 1/t7JGL ~
t./ C r/2..ui. JJfJ r;~ {/f/lt.:( Pa-JIJTl /J(,
Permits are non-transferable and expir; if work is fi1}"-' I,
not started within 180 days of issuance or if work is
Suspended for 180 days.
lif'CONTRAeTORiiNsla,.;r5iTiON70m}Y;,-,j'
2. t8'~,...;J~ ,,;:~-,-~..,..r..' ,~;"'l'~';~_;,h,' ?1"~'y,"\(r"","'~"J'<""",'".~@;"",i(.1 ,"~1;t.'i'~Ir:".:_A"!t"""1i:S
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Electrical Contractor .rh;-i ~t-= 1<'1 ",..t-,.i,..
Address
1 ?qR R"t-h" 1 f),.i""
City
Fllg~nc
Owners Signature:
y .
Inspection Request: 726-3769
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A. RNj~'i~!~i~a~e~!flffi\$in'gi_~~~,:~~Wli!~fh:.n.ilt.\~er~~'~~ilii~g~.~wt L11
Service Included
1000 sq. ft. or less
Each additional 500 sq. It or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19,00
$50.00
1~r'-"1"""~~fz.#" !..Jt"';'rq~..~.'"-' ';.r- .';~kl-'''li;'~'-. ,r, "~J"'I.'T;- j,"'-~'''.:a.~''t.....,.-.... :'j'-., '-":~'l'11
B. ~{,~~i~f~f~~:~:!~!I~~.r~J..t~~!"!~~\i,?~i;_~;I:~~htt~~~~~t\]!.~.I.o~~tJ!~~ih;i,SJ
$ 50.00
$ 69,00
$100.00
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ltt..,~ ..tf<II:.~"""';"..)rt~~r.~1:'_"" H:':~JV.:.';u~_:,':'I'T_ 'it&;....;';".~~~..-~~;j~'..it~~'
4. f!SUB1iO!FAEOEiA'BOVEf..,."'iltit,",~t,i,,;''"~t!'lii
~i..i'i~~",.fi',,~~.:,.:....A.~I'MiJ...I',l:>~~.'j~;!..;t~~1.ijf."'?j;AUI-t.~1t'l:~. 'ft<
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding Forms/Electrical Permit Application 1-03.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:
ELE2003-00145
6/16/2003
6/16/2003
12/1612003
SITE ADDRESS:
ASSESSOR'S PARCEL NO,:
1940 DON ST STE 250
1703270000903
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Add sub panel and 4 circuits
OWNER! APPLICANT:
STRAUSBAUGH GREGORY L & ~
3642 RIVER POINTE DR
EUGENE OR 97408
ELECTRICAL CONTRACTOR:
CHRISTENSON ELECTRIC INC 541,688,6121
1631 NW THURMAN 2ND FLR 543-419,3600
PORTLAND OR 97209
CCB # 458 Expiration Date: 05101/2007
DescriDtion Amount Paid Date Paid Receiot Number
+ 10% Administrative Fee 7,50 0611612003 1200200000000001534
+ 7% State Surcharge 5,25 06116/2003 1200200000000001534
Add. Alter. Extend Circ Ea Add 12,00 06/1612003 1200200000000001534
Perm ServIFdr 200 amps or less 63,00 06/1612003 1200200000000001534
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 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service,
3 Final Electric: When all electrical work is complete.
,0
By Signature, I state and agree, that I have carefully examined the completed applieation anddo hci-~by,certify that all
information hereon is true and correct, and I ~rther certify that any and all work performed\rhail,b~'do;lldn accordanee with
the Ordinances of the City of Springfield a~~~ laws of the State of Oregon perto';,n,i.ng i~'ilie.~~(t'de\~~l!ed herein. J further
certify that only contractors and emplof}~ ".@i are in compliance with ORS ?.9!\055~iII'be used on-.tlils project. I further agree
to ensure that all required inspectio!'8,.~ J!i9i&sted at the proper time, thiii'~acb,a'd'dress i~~~-;;adabi';:fro~the street, and that
the approved set of plans, if apPIi~lsIm~'1I~ll8in on the site at{'n.tiMe;,du1ij,'1i\c'6lm~-uctil.'rl:. '0\ \'(\'" ~'(\o<'>''':'o(\
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. . , ~I", ~~.J ..."';V \0. \c7>\y. ~'-:- (\'v v,,:"''O.\ .".,,\0. .;~'~ ,.... ~..,
Owner or Contractors SlgQ~tUf~" &~ ~o\\\ \I-?> g"'D~.t~>'l (\\e~'" 0<'>' \)\.\ 2:??""
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Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003,OO 145
ELE2003-00 145
ELE2003-00145
ELE2003,OO 145
Payments:
. Type of Payment
CreditCard
.
/
6/16/2003
, City of Springfield
Development Services Department
Puhlic Works Department
Official Receipt
Receipt #: 1200200000000001534
Description
Perm ServIFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
CHRISTENSON ELECTRIC
10:48:16AM
Received By
djb
Date: 06t16t2003
Amount Paid
Item Total:
63.00
12.00
7.50
5.25
$87.75
Check Number Confirm No
000095 086363
How Received
In Person
Payment Total:
Amount Paid
87,75
$87.75
Page I of I
cReceipt.rpl