HomeMy WebLinkAboutPermit Electrical 2003-4-30
,Y; '/" , ' 'CITY'OF s:l,..JNGFrELO; OREGON: :'''(''\'',~;-,
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225 FIFTII STREET. SPRINGFIELD, OR 97477 . 1'11:(541)726-3753 . FAX: (541)726-3689 t 11 wing
mitted has the 0 0
ELECTRICAL PERMIT APPLICA nON ~~ T, he following project as sU~ire specific land use
.. /-, - D J 0 ,","" ' d does nol req
Clly Job Number CLE 2003 - 011 L{ Date 2'-'0.J zonlOg, an f\ (l )
approval. I.:---~_
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j.. ,- .-.....--.-. -,~hon'Zed,Slgnall.Ir...~........-,. -
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A. ;, }~~f~' .I~~sidcht,i;-al_~; .' l~l~I~}~r. ~~~I!l~F~n~.il~~, ~).~~f'~~1tc~~~~~. ~'!~!t1~~d
Electrical Contractor ~ .'t.' , lct"r S C Itt 'i, ie /r'(; 200 Amps or less. $ 63,00
, 20 I Amps to 400 Amps $ 75,00
Address Iqc) Jvlulli=::{,r, 401 Amps to 600 Amps t^ $125,00
'IreS yOU -
. 601 Aml1;'\;/8t\QQOIA!i\\Il~ UtililV $163,00
Phone 4 ~S '~,}Y:n, ~11 E.N 1 ~~d8B~Et~,!'U'fAtl61Qrego; set fortI $375,00
io\\OW ruIR&~IlIl(~"t ~q!)jse rules a~ 95')-001 $ 50,00
NDtilicati~~~~~OW.~h~Q\!9~~~le,r-u~,R,\."._7"'-_""""'"' . _ '
SUIJervisor License Number ?- J. C/O . ~~ '_ Q"R e:~~a'elllJlQri1r.vlltl1!;"IEes,IIr.J'el'dCl'si"n""i;l;"r, M,::,~,..t '..'~r'A?""i',fl'~l~'l
~) lo. f"\. mayuUlQ.:l I :'\ne'te'ev"O....,.-l."'-I'~ '10 "h.:-,'" .,......h~.,...~
0090, YOU, '" ~p(\ter,lNDte, '" '''''n\ilicatIOn
calling n'Stnlla I i'Cjre\jls/llllio,11Ilr RX )OC:I t ion
numbeid6'~\~~SIS(1~ 16oRO-332-234 '
('orner, -
201 'Amps 10 400 Amp~
40 I Amps to 600 Amps
Expiration Date (), i r) - 0 '~ Over 600 Amp~ or: 1000 Volt",ee "13" above,
Sigoa~ure tf,S~UP' 'd,iSi.ogtE'IJeet_r~iCia.-n D. ~~'lJ~'8ri~lltii:c~i~'S;~~;i\I';')'L f~::P~~~:.~.' ;'~~~/',~r';';:~(l.i~1!.~-:\;::~.:,~.;1'~j;Lf~33~:~:~~~~'; ,I~
:u...r.',""'. "".l':.H;!,,.'. ,t,.'.1- ~.".. 'J:L~.'."-~,<,:,'l.\t,,;....;,..-l.'f.,__., ,.:.,~...)..tr.."if..t..~ >-.~,)~'I ,."l-A... "'7<<,
Ncw Alteratiun or Extcllsion Pcr Panel
One Circuit $ 43,00
- , ,.NOTICE: Each Addil~onal Cirellil or with 7 b
Owners Name 6.- (,de' C1 ""fbt4( (THIS PERMTf:1;~At'LI'EW1~E'l~'!HE 'tfgH~,,,.., : ._$, :','~~:~""c" ~"1'J
A<I,I,.e','.., I / (/ /" ~~,~ 0 J s ~THORIE~~,itINbI,rntitW~~~Jf)~~lfl~Ulleli,ded),.i.Elich,I'ist"II"(ioll,t
" 1=0 0 1.=....==,,'-" '" tOMMENCED'OR IS ABANUONEO FOR""'" '''''', . ,'" .', ',".', ,',' '.':',
City L-~kD' (;- j Phone ANY 180 OAlfnljEc51'liilnI{;ation $ 50,00
7 Sign/Outline Lighting $ 50,00
Limited Energy/Residential $ 25,00
Limited Energy/Commercial $ 45,00
LEGAL DESCRIPTION
170~ 272 Z.
oot(OO
J013 DESCRIPTION
fir'\:)8> 3. c-, l2u--,: \--"
Permits are nonMtransferable and expire if work is
not slarled wilhin 180 dnys nf issnance or if work is
Snspcllded for 180 days,
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f'eONFRACTOR.'INsrAiiJA1'loNOiilLy'j
2. . ~-tr ~~~-t~t~.f.ip'.]"r ~'I'.'\!!.f'~~~(!::',li"'~'1!:.r. :iV!l'~-. <..N _,
City
[\ )~fn~
Expi,ation Date 10' ( 'G I)
Constr. Contr. Number
/;JCj (p
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
Ser,'iee Inclnded
1000 sq, ft, or less
Each additiollal 500 sq, ft, or
portion thereof
Each Manufaet'd Horne or
Modular Dwelling Service or
Feeder
$106,00
$ 19,00
$50,00
\,V.. ',~..~':': -::~""Tr''''~'ro: -:" ~'rr .-)1;' '7?'~r"'~'J~' ':-~':.""~~~~~r.ft'"';7Tl~W'"l'':''i-t'~\:1
n. .>.~.ei'\'.~~i, ~.~: f~~d.~I's':'; ,In~t~~!~.t~~,n~:~!t~i;~i~op's. J),i~~cl.{~s~!lo~n:;:r;"1
....I.., . --"<<1. ~,~ I . c. ,.. .....11,:, _ :.1-, ,,--.~ .~..1 . ......!l " .'1!.., .l...... ;h.: ....'>,le" Jr..... ~,,[:: 1'......--' .. ....f.I'1
$ 50,00
$ 69.00
$100,00
I\lillirnllrn Electric I)errnit Inspection Fee is $45.00 + Surcharges
4. r"~1ffit6fAl1JF1h6vffi~~~~t!~i(;l~7;ll:\Jlf~ 110,
I,'it-I" ':'f~:"2rLf.:J'II; .:H.;.......~:-;..~~.:\~-~.~~~~~11~e~ti'~b' i-~w.~ 1:~ '1 (
"]1.{3
l/'10
'5 '7 :]7
7% Slate Surcharge
10% Administrative Fee
TOTAL
Shared Dri\'c(T:)fBuilding FOml.'l/Eloctrical Pcnnit Application I-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 Iospection Line
PERMIT NO,:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00114
4/30/2003
4/3012003
10/30/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO,:
1193 HARLOW RD
1703272200400
Spriogfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Add 3 circuits
OWNER/APPLICANT:
CAMPBELL CEILLE W TE
668 GREENWOOD ST
JUNCTION CITY OR 97448
ELECTRICAL CONTRACTOR:
BUILDERS ELECTRIC INC 541-485-0922
195 MADISON ST
EUGENE OR 97402
CCB # 4296 Expiration Date: 12/1 0/2003
Descriotio":
Amount Paid
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add. Alter. Extend Circ Ea Add
Date Paid ~eceiut Number
04/30/2003 S '101,) \0 120020000000000 I 099
04/~9/~Q3\\e 01\ \)\\\~'l (\X 120020000000000 I 099
~04130/29Q.3:eg Se\ ,0 '\ 120020000000000 I 099
," '0\,>,,0~~;e&W-~~~~~J:, ~~ 91:::1::~~ '0'> 120020000000000 I 099
-('\ -c:." .r '<l-"-' '\ \W- I\~' IV"
To Request an inspection call the 24 hour recordmg atJ~~3'1~gel.:'lll(insp'es~6h~~rl(~meste~'befQr'{.7:00 a,m, will be made the same
working day, inspections requested after 7:00 a,njoWi)! be\made the.fo'il~*ing\W:d&ing)diiY~~,~ c~'i.\ol\
NO\\\\C~'o,S~.Q~:, O'o\~\I~,,\o\6"\~:'" ~oW\
'u". I,) W-' I\\\:l'" U"" . ~tl,"'"
Reouired Insoections: \~Q9Q'~~9\~eC~eOle9~~_~~~-Z
1 Rough Electric: Prior to Cover C~\\ :oel \01 \el is ,\,~
2 Final Electric: When all electrical work is compi~~ eel\
4,90
3.43
43,00
6,00
By Signature, I state and agree, that 1 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
tbe Ordinances of the City of Springfield and Ihe laws of the State of Oregon pertaining to the WOr.~k described herein. I further
certify that only contractors and employees who arc in compliance with ORS 701.055 will b~,Sll'if.o this project. I further agree
to ensure that all required inspections are requested at the proper time, tbat each ad~eS,S:?I'i-r~~ e from the street, and that
the approved set of plans, if applicable, will remain on the site at all times duri-i,\c!n~~~!foriiJ'\\
\>-\.\. ~ y,,f:J '\l ~'t.\) \-
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Owner or Contractors Signature \\\) \ '?'t.'\\\t\ Ii) 1J~'I'>\tS \>-\)1""
,y..\'O y..CI'\\\1.\:: x.\) CI'\\ ~\CI\),
1>-1J\~\h't.~\j ~ '\l~
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department ~I
Public Works Department.
Official Receipt l'
Receipt #: 1200200000000001099
Date: 04/30/2003
Job/Journal Number
ELE2003-00 114
ELE2003-00 114
ELE2003-00 114
ELE2003-00114
Description
Add, Alter, Extend Cire
Add, Alter, Extend Cire Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Amount Paid
Item Total:
43,00
6,00
4,90
3.43
$57.33
Payments:
Type of Payment
Check
Paid 8y
BUILDERS ELECTRIC
Received By
djb
Check Number Conllrm No
How keceived
In Person
Payment Total:
Amount Paid
57.33
$57.33
.
.
4/30/2003
IO:30:IOAM
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