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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