HomeMy WebLinkAboutPermit Electrical 2003-4-25
Apr-22-03 07:32A
P_02
I
ing project as submlltad has tha fo"owln
225 FIFTH STREET. SPRI."GFIELD. OR 97477 . PH:(54l )72(,,3753 . F,"X: (54lli~f~~~?nd doas not require spaclflc land Use 9
Zoning. (1 (l
o '-(ZSD J Date S-- , - a ~
C01l1PLETE FEE sc1iBlIJm~~lil&l$ _ ~J
ELECTRICAL PERMIT APPLICA110N
City Job Number ELI:2QO 5 ~OOII f Dale
I. LOCATJONOFI^~STALLATIOt 3.
2-7.5 0 G-f>,:-n:::yJ ~'>f-t?b/.z
LEGAL DESCRIPTION
.---.1.70'~ ZzDD
.lOB DESCRIPTION
OZ3fX)
/
c. CrY U4..5JL~ F
Penniblll.re non~ti'8nifcroblc and expire if work is not
started v..ithin 180 day" I,.""fi~j.i~"l.nce or if work is
Su<oended for I BO days.
CONTRAGTOR INSTAUATION ONLY
2,
. -7 -
A. N..., R..idellii.l- Slngl. or MlIhl-Famn1' p"r d".lIln~ unl!.
Servi.:e lncluded
1000 sq. ft. or less
Each additional 500 >q, fL or
;>onion thereof
Each Manufacl'd Home or
Modu!ar Dwelling Service or
Feeder
SIOMO
$ 19.00
$50,00
SE'fvICe!l or Feed~rli - 'ns1l1l1ation~ A1tl'rAtlon~ or Rdocouon:
B. " . : I.
EleCllical Contractor kRAvto ae.cie(C 200 Amp, or less ___,_ $ 63.00
201 Amp, to 400 Amp, $ 75.00
Addre" 'PO ~ 1160 401 Amp' to 600 Amps ____ $125.00
601 Amps to 1000 Anlps $163,00
City S;1!u~ Phone S'G!3 Si'<6'( /y,~( Over 1000 AmpsiVolts $375,00
Reconnecl.<?~Y :" ..' .'~" ""'. ~':J~~O:~o.,..
Supervi!lorLic~m:eNumher /<i5; 29 s C. TenlPorarySen'jce5or Feeders _.. ._~_._.,
~''''''':i',''"'''' .'."" 'oO"" NOT\CE: [;jt8il~t)on. ~1t~ra~r~&I~atiOn - ..., -
E.plrauon Date [1"\T SUA"" E"PIRE IFl . -.. ..... oO--'
. ..' :.. ,... ' , ' .. .. ...... - '-1113-f[ 10.. 0 .uNO~'{~r;~l'OOroAlT IS NOT $ 5000_. _ _.... .
Constr, Contr. Number /5 z.. 36-A1JTHORIZ~EO 'OR r.gIMJJll1ll~~.I;\\t:;' _ $ 69 00
. :,:.,,":- ;.tfil,D:r.' COMMtNv PEo4D.I-Amps 10 600 Amp' .~'. " . _" .. .....,.~ $100.00. ".'..,
E.piration Date '1" 0 7 ~ 0 ~~ <w.O OA.y n~~~'600 Am;s or loo~ ~Olt~"~::'B': aha,,:'" ,'.
.. D. . BI"anch Clrcuits .
Sign~f"d :;t
~ 0"/1
\J
O~nn';;; Name IA R.G~'- ~
Add;:;;';;" Po (? 0,1( 9ir.}b
City J1/tVM e z:r ~ I,f,... lR:.i
OWNER I;\,STALlA TIOr-;
The im:tallation is being made c.n property I own
which is not intended far. s~I:::,. lease~ or J'~nt. _ . _,
. .". :" . : '.' . ~ ,"'
Owners SiGnature:
.:-:..::.\t'!1:~' (.r _>- ,: .1{:U...'~~:;;~
': t' :\-.~IF;... 1,>;<';
Inspection Request: 726.376'i... ..
;.';,!~:'.i: -:. ,-. ,....j. -'1"' '"J'.
New Alteration or Extension Per Panel
OneCircIllt
$ 43.00
Each Additiunal Circuir or ,,'ith , ,
Serv~H~Cfffd~fegon law ioqUlre% 98B tv
E. 1W'i\9\lm..il!'!;(~~$~i!~1!Iy' !IY.!lie:I~'Y'l!lftjfRMnstallari"n
Notification Center. Those rules are set fortt
~~~.Mirri.llj2~eOl-00l0thro;;;;;~. 8,^.Ff~~'~::oo~
~j.nJOotline U..hting b' . ., SSO. O.
'UU'dV.. 'uu fffc1) 0 taln co"""" do (,,8 ru AS uy
LimitedIE~!i.Y.'Re.,dcnli.l (N t,. 'L, ,., $ 2',00
",u. 'II.~ ..1c \"CllLtif. 0 .... .:...... .... ttp.i'lone t:I
.' Limitod,EMW1Commerdal U"!"lC,,,,S 45.00 l/,,~
"UnlLJl;1 ,;), IIIC\..lTHI10n .1 ioy ''fUflrICalIOn-+-
.~. ....: Center is 1"800-332-2344).
Minimum,EI<<tri< Permh Inspecrion Fcc is'$45:00 ,+ Surcharges"
'. ~L"! .!......'.....I'" ':-...... ,.-.... ..."V"
.....- q -~._'._._-'-
4. SI.!B,T01'Al.:,QJ,:ABDVE .__ _ ~ '!" (;1, l!S" ~o ..._
7o/~~St~f;S~~ci~~e ~ ,C .,'; 3. IS-
J()4ib Administrative fce l.J. r
...lUTAi~C1" ~...~~~~ :~'. : .~~XCI!l:U . S':1 . .L~-
fC.J::t';i"'. .:.\'~ ":...,'~s..' ....{ :.... ~~ ."
,~"_ _ Sl~~\."d. pri~'c(T:;'Buildjn~ 'Fonns/E1Cl:tri(aIP':nll!~ ~pplicmi{ln'!.OJ,d{l(;
i-
.
.
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:
ELE2003-00111
4/29/2003
4/25/2003
10/29/2003
SITE ADDRESS: 2750 GA TEW A Y ST
ASSESSOR'S PARCEL NO.: 1703220002300
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Commercial
PROJECT DESCRIPTION:
CCTV upgrade
OWNER! APPLICANT:
TARGET STORES #612
% PROP TAX DEPT
MINNEAPOLIS MN 55440
ELECTRICAL CONTRACTOR:
GRAYCO ELECTRIC INC 503-881-1881
PO BOX 1160 503-873-3384
SILVERTON OR 97381
CCB # 152363 Expiration Date: 07/30/2004
Descrintion
Amount Paid
Date Paid
Receint Number
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
4.50
3.15
45.00
04/29/2003
04/2912003
04/29/2003
1200200000000001084
1200200000000001084
1200200000000001084
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 follov,Q\!8 working day.
, ..'O",'l'
_\,e~' _~
X. \t I \';, ~v .
Reauired Insoections: . ~\. 'i:.~,?\~ '?'i:.\\~\\ to\\
1 Low Voltage: prior~O\Sq~~~~~~\\ ~~~\\ \~~~\)()~'t.\)
By Signature, I state and agre~~\iha1,:.1i\il~~carefulfy: ~amined the completed application and do herehy certify that all
information hereon is true an4~l!6ii\~t.'l\.Dli-'ff~liIDeei1ify that any and all work performed shall be done In accordance with
the Ordinances of the City of Sl!.atJ~f1\;J'tijJ'li\lie laws of the State of Oregon pertaining to the work described herein. I further
certify that only contractors aDlI,!!.ijtpfu~ees who are in compliance with ORS 701.055 will be used on this project. I further agree
to ensure that all required inspections are requested at the proper time, that eaeh 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.
. n law reqUires you to
,,''-TH\I \ IUN.Ulego . "'-.____ Iltililv
Owner or Contractors Signature f'ollOW rules adq;ji\Wo uy U .ou~~- ;re set forti
Notification cent~~16~~~:~gh OAR 952-001
in OAR 952-001- . copies ofthe rules b\
0090. You may obtain ote' the telephOne
calling the center. {N Utility Notification
number for the.ore8g000n_332_2344).
Centefls 1-
Page 1 of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 III
ELE2003-00 I 11
ELE2003-00 I 11
Payments:
Type or Payment
Check
4/29/2003
City of Springfield
Development Services Department
Public Works Department
Official ReceiPt
Receipt #: 1200200000000001084
Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Paid By
ARTHUR HEITZ
IO:00:14AM
Received By
djb
Date: 04/29/2003
,
.
Amount Paid
4.50
3.15
45.00
$52.65
Amount Paid .
52.65
$52.65
Item Total:
Check Number Confirm No
How Received
In Person
Payment Total:
.
Page I of I
cReceipt.rpt