HomeMy WebLinkAboutPermit Electrical 2003-1-22
,- ~ . '. CITY OF'S} cdNGFrELD OREGON' . i '; :;:
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 , ,
ELECTRICAL PERMIT APPLICATION rhe following project as submined Ms the following
'. zarling, and does not reqUire specIfic land use
City Job Number ELl=-ZCO.>-OC>OIK' Dale 1- Zz.-03awova" c.. <L.
& __IAn 700;0'\ '.,
L"LO'.eA. ':tiiJiViOp..iNST.. :Xfilt4.ifjbiVl;:fJ.(1f:~~i:"1 . 1 Ig~~' ,'J!:'ioS'tliml)JJiilllBjfij"oJ.iT.ifJj::!.;~3';i;03j~i"'!l
~-. ~-." .__~_("..~~'.'r'>. c,_,__._. --'"~-:'''he.tOttc;'wf~t~~~e~~~S;equ;;'~~~~ -~:' -,","~"",^--,~- '.", - -' _.--~~ -- - --.~~.;)t
/067 dltil.-t.{fl.j /2.(). zoning, and AUINlUled Si~nature <:::ti v-.J
LEGAL DESCRIPTION appruv g. 'zoning 'v"';- ~-"~~r. .ej~~.e:/sr/gl~]fs~~Xit~~~jm~i~!p/f~,~;'ii_!!!f~~~~Tt..~~~.:?~ .
{703 2-Z.3'3 ooL(CJO {/
E:.~'"
d S'gnature
Au\hOfil8 I
.I E'Ir1poflAMj POIMGYL' ~ f!{)1J S 7'/W.L.7JcJ _
Permits are non-transferable and expire if work is 'SITE
not started within 180 days of issuance or if work is
Suspended for 180 days. .
I uuu sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
$106.00
JOB DESCRIPTION
$ 19,00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
r!€ONTJtA{ff{jJii1NsTMjf;;fTioNl(jNIJf1~
2. f:"-~ ;'; 'al;,., :"''''~...'1\-:,~ri~t-'',Il\''::'''ti'- ,~J),:,',':''"; ,'';.:H~lA!,;.~:~
B. ~~~~ls~f.F~~a~~~~;~~liiiofiiiii~1~t~~~'ti~~s~~;~jfeI6'~'iti6it':tt~
~!"''':''''',.i,,,~~~,,,_.j, '"r]\;r'...~ r.t<"t:!~:'_':.''''''\'\''~'i-'f:~.,.l,..,-\,'.'',_;ii>,.L:;r'.., ;'v'~ \...;,u"',:.,".",,:.j. ... " ','.
Electrical Contractor r.HRT<;TI"NS(1N I'1FITRTr.) INC. 200 Amps or less
201 Amps to 400 Amps
Address 1 ?q~ RF1'l-WI ..D1H\TF 401 Amps to 600 Amps
601 Amps to 1000 Amps
City EUGENE Phone S41 -f>RR-f> 1 :u. . Over 1000 AmpsN oils
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
C ~~T"'" "'., :"'S'"".'" ""''''''imRl\1~h''~''''~'>;+:'' "'1:.',",, -...,o/1l:~.::"l
. ,emporarv.!: er.vu:nE\nr:.'I<:e @_\.l.{{ll~-': '.... ..~;>:'t:J-~~\~I:"IfG' h' ~'v
.... . ",'. ...-..... iCf'" . ..... .~.., . .
, I'l~Of\\'c).\eOle~. Se\\O' '.
~talhl~l~te~at~!1.lof.lR~!g5atiOQ'\
~,'\'t:.\~~~O;~RtQiliaqs~~\}~Oi>-~ e'l~\es y~ $ 50.00 q) ~
\0\~~'I'l a.\~1 ~~'Wlh"~~s 0\ \~\e\l"o"d _ $ 69.00
~O\I\~~ \!,e,P:~I1s.:\'9'6illJ Xni~.\~e ~o\i\iCa."'V' $100.00
'nOr ",,'I ((Ia:j _~AI"~~..I\\I!\\l ,.. \
I" gO. vve~.6QQ;roiiii~.Q,lidJ\JW 'lollSl~I"B" above.
00 cD\\~~~~~i~~~Mj'i"~i1~t;ii"~I)"'",,"ful~I;t\l'.,.\.w'i\!J;'.,,';r"\f.'0i!!i' ;"'.W'I''';'jUh1i.l
\~~\"m:~'f\"" ft"~~~';J.,:F;:$.lr~~a~J*~~j'!{'*+:W, 4".~~tl'.<.,~~/ -;.!~~~i
(\\)~ew fu1~~~ti;n or Extension Per Panel
One Circuit $ 43.00
Each Additional Circuit or with
Owner> Name {;J~tlAw.ef!.e J1/(:;J (M1L LLC ~:::,::'j~:~~:,:::i:. '" 'ii..n~""1:1 ;l.\I:;A~~~"~;","_~,~.~"
07 r D.11" #7"'0 E. '~1VIiSeelIlln~iUil(lO:";;'i""'GeaerJnci'f:fu ~ld ""'clilInstauiitlOil'
Address 7.) F1..... ':3,'T 0 IlffH\SPt:1~ ~~.t1\:t '. .... .,; .'..
City ctA. 6-f::;To( e Phone PutMlo,\Ilt!llIlJJrl Uoo IS I\BI\NDONEO fO!\so.oo
sig,gQiUIiA~tR\'gli,\1ri~ER\OO. $ 50.00
LimMI!1'E~~~sj(Jential $ 25.00
Limited Energy/Commercial S 45.00
Supervisor License Number
27195
Expiration Date
10/01/03
Constr. Contr. Number
?k_'J,/,r.
Expiration Date
10/01/01
Signature of Supervising Electrician
L3/
,
NATHAN PHTT .TPS
OVVNERINSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
4. f1saBW6>T~Ol?~@:imi~~%\~g~~~~;~~;i':4
J':Jt!'.-:t'.t~,~HJ':\it<i:!'~itl~~{)!~~',~lf:~~~"l.\vJ:li,;;r::SV!i~~i;:'''~~~
5;D !J5!
7% State Surcharge
10% Administrative Fee
3.~
5dXJ
513.5"0
Inspection Request: 726-3769
TOTAL
Shared Drive(T:yIJuilding FormslElectrical Pennit Application I ~03.doe
.
.
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:
ELE2003-00018
1/22/2003
1/22/2003
7/22/2003
SITE ADDRESS: 1007 HARLOW RD
ASSESSOR'S PARCEL NO.: 1703223300400
TYPE OF WORK:
TYPE OF USE:
New
Commercial
PROJECT DESCRIPTION:
Temp power.
OWNER! APPLICANT:
WILLAMETTE MEDICAL CENTEI
975 OAK ST # 780
EUGENE OR 97401
ELECTRICAL CONTRACTOR:
CHRISTENSON ELECTRIC INC 541-688-6121
1631 NW THURMAN 2ND FLR 543-419-3600
PORTLAND OR 97209
CCB # 458 Expiration Date: 05/01/2003
Descriotion
Amount Paid
Date Paid
Receint Number
+ 10% Administrative Fee
+ 7% State Surcharge
Temp Power 200 amps or less
5.00
3.50
50.00
01/2212003
01/22/2003
01/22/2003
1200200000000000586
1200200000000000586
1200200000000000586
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 am. will be made the same working day,
inspections requested after 7:00 a.m. will be made the following working day,
Reauired Insoections:
1 Temporary Electric: Approval required prior to Utility Company energizing pole.
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 further certify that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I
further certify that only contractors and employeefl'tfiPl~'n compliance l~gl O~~ be used on this project I
further agree to ensure that all required inspectio'1~.rS fl'SHMtildS/tlfful-pi r,~ r''''~\!l,ddress is readable from the
street, and that the approved set of plans, if applicap:ul1tU\{i~8ii!J!lilllh'il ~ \~t I e~a~lOg construction.
COMMENCED OR IS ABANDONE U
DAI( PERIl)':
Owner or Contractors Signature AN~ IOU Date UITes'/ou.'~
n laIN Te~ on U\\\lW
E,I'I\ \OI'l"OTe~~ b'/ \\'Ie OTe~Te set \oft"
jl..\\ uleS adoll ,\'lOse TilleS p. 952.00~-
\01l01N T, n centef. \'ITOIl9\'10f' TilleS b'i
NO\i\iC~~~2.00~.00~~~ collies 0\ \\:Il\'lone
in Of'o 'loll {(\a,/ o~~ ,No\e'. ~~e ~O\i\ica\iOn
009 " \\'Ie cen ' n U\\\I\'I
ca\ll09 \OT\\'IeOTego _332-2344)'
nll~beT 'eT is ~ .eoO
cen,
I of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line I terns:
Job/Journal Number
ELE2003-00018
ELE2003-000 I 8
ELE2003-000 18
Payments:
TWe of Payment
Check
Paid By
Description
Receipt #: 1200200000000000586
Date: 01122/2003
Temp Power 200 amps or less
+ 10% Administrative Fee
+ 7% State Surcharge
PHILIPS ELECTRIC
Received By
Check Number Confirm No
djb
Page I of!
\
1/22/2003. '.
1 :32:42PM
.
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
50.00
5,00
3.50
Line Item Total:
$58.50
How Received
Amount Paid
In Person
58.50
$58.50
.
Payment Total:
cRcceiptrpt