HomeMy WebLinkAboutPermit Electrical 2003-5-8
, -::> CITY OF S~)NGFIELD, OREGON , 0
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION r k The tol/owing project as Submitted has the tol/ I
. zonmg and does not. ow n9
City Job Number FrJ2Zoci?- cD 12.0 Date .:::s: 8 (5:5 approv'al. require specitic land Use
3. . CO{IPLETE FEE SCHEffLi.~'1.u.,LV ;.; (2 c..
. .. "'Date '" - '7 _,,~
,p,p,,~ ~CLE: !.1'5~ 6A,TE:,~"''( Authorized Signature ' Kv-
LEGAL DESCRIPTION (703, 2200 OZJOO A. New Residential- Single or Multi-Family per dwelln'ig UlIII.
1~~\o-4L ,..Hl::ow a.;)jLo~ Service Included
I.
LOCA110N OF INSTALLA110N
JOB DESCRIPTION
~~~ ,,..~~,-,-ofr1'\"'N
f A~n ~ I r f!" ,,","""110"
P~lts are non-trlri'Sferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
1000 sq. fl. or less
Each additional 500 sq. fl. or
Ilr:l' n thereof
O'~b~
Ea 1 Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19,00
$50.00
2.
CONTRACTOR INSTALLATION ONLY
B. Ser\'ices or Feeders -' Inslallation, Alterations or Reloeation:
Address
200 Amps or less $ 63.00
201 Amps to 400 Amps $ 75.00
40 I Amps to 600 Amps $125.00
601 Amps to 1000 Amps $163.00
Phone ;~4 - ,,~,,(. Over 10000AmpsNoIlS $375.00
ReC~mi~t.OnlY $ 50.00
. n _ " I liAS o.~,\e"'o~'Si.~~~~ . - n .
Supervisor License Number ~ - '1' I ~ v L ,'cl-~ \e~\eTe~p.o~ar~JSh\'iees or Feeders
. 10' I IOn9P'.' N\,\\e ~e",'cl-\~,9J~~e"''O) -
Expiration Date . "31 ~IG. 10 I 0 \- P.-c\'O ",13 \~lns1'.rllatioit~Alteration or Relocation
'- ' '~,\\o" c." \ \\'- ~O'- ~
....~":"''O'l, :,,\. \".",\0~200~mp~",1Ie"~0
I "1 ~,,~ <.:-,,,, :\v'" ",,,,- \:J .~'v'C'
... ~~.,~ \~ ~ ee . (\0 ..... c.O\20 I~mp's<to'~oo Amps $ 69.00
- ,&\\' !\e. ~ \...
I I \~~~,c.'cl-\'~~~O\):IO'O'I! ~ ~04l{!.\~~P.~IO"'600Amps . $100.00
Expiration Date ,; I 0.,.....,' ..... g ~'cl-) ,,\13' ,,0'" nt).'/;
. ~ _~Y'_ ~ '" v""" O~e", over 600 Amps or 1000 Volts see "B" above.
.~v 'IV ':(\13 ~C5"''' - . . -- - . -. . --.
Signature of Supervising Electrician~ f\09JO. ,,\<.:-Q, 'Ii "o~\,\\e . '" '\D. ' Branch Circuits
v c.'cl-" ~ \ ,?p . . , . - -. -
.. \. (j. \ t\ ",~~'Oe ee"''1 New Alteration or Extension Per Panel
N(.IVl t'\ l..- ~ One CirCUIt $ 43,00
Each Additional Circuit or with'
Service or Feeder Permit \,\'1,. $ 3.00
'I'l\.l I
E~. ;1is;~lIan~t"t:.'1-~~~t~r"nJl\~1hlll;d)~Ea;h i~'tall.ti~t;
~O,\C .' \i ~\\~\.: i\\\~ \> t,U TO\'- -
i\\\~ \>;I'il~ ~~!?di~~'O~"oO~ $ 50.00
~\li~ if!RL\'il~\)ng 1 $ 50.00
co~\Jtlf~~ ~es;dential $ 25.00
fI."'{ Oifn~ted EnergylCommercial $ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Electrical Contractor, N~ lJ..., \ '"{\.I~'\r5
~q~' w. I\""',.../fc.
Address
City
~""...~ r.:.
$ 50.00
Constr. Contr. Number
Owners Name "'T ~ Crt:r
-:; Tuzc-S
7d
~Ol"
7<;- ~ b
City)Ii~,.tE'o< toL<. ;1fd Phone
so
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
4. ' SUBTOTAL OF ABOVE
7% Stale Surcharge
10% Administrative Fee
-0
)
350
500
sg~
Inspection Request: 726-3769
TOTAL
Shared Drivc(T:)lBuilding Forms/Electrical Pcnnit Application 1-03.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:
ELE2003-00120
5/8/2003
5/8/2003
11/8/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
2750 GATEWAY ST
1703220002300
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Tube installation
OWNER/APPLICANT:
TARGET STORES #612
% PROP TAX DEPT
MINNEAPOLIS MN 55440
ELECTRICAL CONTRACTOR:
NEAL H CONNER 541-344-6366
3430 W 11TH AVE
EUGENE OR 97402
CCB # 63871 Expiration Date: 01/31/2006
Descriotion,
+ 10% Administrative Fee
+ 7% State Surcharge
Sign - Outline Lighting Each
Amount Paid
Date Paid
Receiot Number
5.00
3.50
50.00
05/08/2003
05/08/2003
05/08/2003
1200200000000001150
1200200000000001150
1200200000000001150
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 Sign Electrical: After connection is made but prior to energizing
By Signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and.I~'f~rl~r~certify that any and all work performed shall be done In accordance with
the Ordinances of the City ofSpringfield,gii'd~h1,"il'Ws:ofthe State of Oregon pertaining to the work described herein. I further
certify that only contractors and employ'ee~ho:~~)~ e?~pliance with ORS 701.055 will be used on this project. I further agree
to ensure that all required inspection,sftl're?'equ"'ested a'J"'ihfpr{lper time, that each address is readable from the street, and that
the approved set of plans, if applic,!ible;~illfrem'fti~ro'n:tJll,.~tl, at all times during eonstruction.
"," ~~ ..:::i ';(;:oV ~~ ~'O'Y.''S:-v
~ 'Q g,0,)~ g,0 ,'0 ~
.0 _'0 .0 " . ('t, .0 ~ .......
Owner or Contractors Sign~.Meo~V ~":' '\;)"S" vO'l.~0":>'#' rJ<
~ '7>~ ~'O s;:." .'" ~O ~~ a;<l.;
_~ g, 0~>:3 ~~~'" ~
<("," ~'O CJ s;:.'" & 0'.... ~ ~":J
~ .,"- O~ \:l "" ~ ~flj ".::j
~ ~O~ ~ ~'l; ~'b' v'O '00 "v
,0 .'S:-v /)..05 ,:, ';(;:0'0 -IS' .{:>
~ ~. ~O ~ ~ q;.
~o 0' ~ ,0 ~
".", p;>\;)':i!ii>~ 0' eJlj
"\;)1::5 v'1i~
~'5
R-'t-
,~\) ~'\
. v
'\~'(, ~S ~
~~ ~'\ ~<(>.
{$~ <('<.,~ ~<::) <.(
':v" ~ '\~S ~~~
S~~ ~<(>. 'J:>~
~~.# \::;~<::S9~
...\.~'\'\ <('<.,~ ~'<.,<::) ~<(>. ~~<::).
\.'\~S ~~*' ~'.J'<.,<::) ~ <(~
~~~~~'O<::) <::)'f.
<:J~
~
Date
Page 1 of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 120
ELE2003-00l20
ELE2003-00l20
Payments:
Type of Payment
Check
5/8/2003
City of Springfield
i
Development Services Department
Public Works Department ;,
Official Receipt
Receipt #: 1200200000000001150
Description
Sign - Outline Lighting Each
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
NEON LATITUDES
Received 8y
djb
1O:45:22AM
Date: 05/08/2003
Item Total:
Check Number Confirm No
How Received
In Person
Payment Total:
Page I ofl
Amount Paid
50.00
5.00
3.50
$58.50
Amount Paid
58.50
$58.50
.
.
cReceipLrpl