HomeMy WebLinkAboutPermit Electrical 2003-8-13
. . (, .
.
.-
City of Springfield
Electrical Permit Attachment
Status: Issued PERMIT NO,: 'ELE2003-00189
225 Fifth Street ISSUED: 8/13/2003
Springfield, Oregon 97477 APPLIED: 8/13121)03
541-726i3~~PrS~~Uregon law requires you to EXPIRES: 2/1312004
541-7t8~J I ut~ adooted by the Oregon Utility
541-~,fv~-;~~8~~I~~!:~~~.~~~~ItlS r~le~~~e^:e: ~o~ NO~I~~~'''T CUll! I FXPIRE IF THE WOk.~
---- --- ---- -- -----
0090. sicrn 1\E>ElREss::n c1'475SHENDERsON A VEAUTHORIZEO UNUt'~e'nroNEOFOR
ASSESSa~is!p At'{CBtI1Jb~: (Np/03'3~13ltl~~hone COMME NCEl1~IQF'WCJMt::
numoer tor me uregon utility 1\I00111caflon ANY 180 DAY pt'FIii3\Q)F USE:
PROJECT DEscRfp+ION~00200?Afi;~"s\~vice
OWNER! APPLICANT:
SKILLERN INVESTMENTS
PO BOX 714
SPRINGFIELD OR 97477
LIMITED PARTNERSHIP
POBOX 714
SPRINGFIELD OR 97477
ELECTRICAL CONTRACTOR:
BUILDERS ELECTRIC INC 541-485-0922
195 MADISON ST
EUGENE OR 97402
CCB # 4296 Expiration Date: 12/10/2003
Descrintion
Amount Paid
Date Paid
Receint Number
+ 10% Administrative Fee
+ 7% State Surcharge
Perm Serv/Fdr 200 amps or less
6.30
4.41
63.00
08/13/2003
08/13/2003
08/13/2003
2200200000000001387
2200200000000001387
2200200000000001387
To Request an inspection call1he 24 hour recording at 726-3769, All inspections requested before 7:00 a.m, will be made the same
working day, inspeclions requesled after 7:00 a,m, will be made the following working day,
Reouired Insoections:
By Signa lure, I slate and agree, thai I have carefully examined the compleled application and do hereby certify that all
informalion hereon is true and correcl, aud I furlher certify that any and all work performed shall be doue in accordance wilh
lhe Ordinances of lhe City of Springfield and the laws of lhe State of Oregon pertaining to the work described herein. I further
certify that only contractors and employees who are in compliance with ORS 701,055 will be used on this project. I further agree
~ ensure that all required inspections are requesled allhe proper time, lhat each address is readable from the street, and lhal
~ ~P?\t: :a:s, pa:PIi~:b:e, :il: remain on the site at all times dur;;r~;:j;n:m ~
Owner or Contractors Signature 1 Date /
Page I of I
";'''~
\0\\0 0
~~VS
. ,. .~\e6'(\.."" \f!:;
0'O~\ s90C
225 FIFTII STRlmT . SI'IUNGFIELD, OR 97477 . 1'11:(541)726-3753 . FAX: (541)726-3689c\0SS <t?\'~ I'
. ~ ~~b ~
EU<:CTRICAlJ:l.\RM,lT APPLlCAJJ.ON ~ \0"'\"~~~0S"0 VJ
City .lob Number t::/.E,::;{ {Jb!, -{)(J {'67Date (')O,~ ~"e ~~~, 1>,,6
1,,0(\ o-J'3.\' \{\C6
I, WE.Q&i1r6fj{6IfiN.~tAiJiJ;4'l'jqjy>:;.t.:t',;.~ 3. ~i;OM'i;.f..Ellf~Wlfsj3~~Y.V-ti{'::~:Oir~~i:;t.f~3~lEttq;f:,f
~ _~.~4,_~_~".,.__ __L_ _.~_i~.__)..,_""",..,, ,_ fJ..t., _..._,~~~ ..1.:..__._...... ______........._1.__ .., .._~:\.\),..~_.....,.,..Jt .3:t~.:Jf - -.~-",
/ Lf- 7,CS ~rvd.2 ^~ Ol>\e /' .6 <;"v,,,I>
LEGAL DESCRIPTION A, '~~,i;tiesi,,~;{1i;I;:S,iligl!te'}\'~f~i!i::"'i~1MiIT,;~~;~~'~liJ!iU:ifJil!~1~iJ{
l _'..~. ._. _~. '." " ....._......,.J.<-............._.-..i~_~'S:::i~..~..~........;...
;" , ',.~. Crty'OF LJ.INGFIELD OREGON J : (-\'- , "
, . , "..J. .,
.. '. . I. ~ M . > .'
.Io?iPFe~IPJW~re90n law requires you to 1000 sq, ft. or less
~ I d d::.b'i t~~ 0 urn Each additional 500 sq, ft, or
~~;:'';;('" S:.., .eF.~~<;>(;!:Jl~311,1':!~ p0l1ion tilcreof
1l~l\!lIllH".!l~f!o[l~tra[l~fei'a!ile{an9~explre]m"'ilrRlis Each Manufael'd l'lome or
n..,,'tartedlY'ithin, 180tdavs'..f,i'suance'o";if,><0r.k is Nn1'IIv,dt.ll~r Dwelling Service or $50,00
-v\J;.:Jv. IV .......y >J1oJ ........, ...'t,;I""'f........... ...... ,Ul..._ UJ:'e~'dJ1
Suse.'ill~ff/l8~E1~~~~~t: (Note: the telephone THIS F.'E~MLT. SHAll EXPIRE IF I Ht vvunT\
mJlClJ:j"'~l>m=-A'E1"'~~f'lm!JV:m'5'mffimm';:'j i'~'''' , .' '; .';t}f.'To"/F,:,r.');f;t ~"'l' )r.;.KIfiT7'W'c,o"",{., ",o:y.;';\n<\1
2, ~,' .IfiWv:J:~<fil;lglqN:,;7"Jruql1()lV..:U!J!:'fi tru 'f~Qlw~ri>.r;.,~~..d~rs'- fi~sta\!lItjonJ '-;1l~t~lI,o.!'~ cii'i~e~~~!io,ii~\':j
.. "TeenIer-Is 1-800-B3'2-'2,{4'4)( ~~.'L .,'V, , COMMENCEO'OR'1~ !\tl'AiiffJONEO' rDR .,=--'--,.," ,",_,',,~,,_""b....
Electrical Contractor RL' i lct"rS E lEt ~II( Ire At'-.i2pq&9'e!\'\'r!e~'f,IOD, / $ 63.00 ~ ~ csD
20 I Amps to 400 Amps $ 75,00
401 Amps to 600 Amps $125,00
60 I Amps to 1000 Amps $163,00
Over 1000 AmpslVolts $375,00
Reconnect Only $ 50,00
Address
jCjc)
/vILi( 'i i;:,( ;1"
City
t: t )?)t:. 'n'
Phoue L}.1;C:-:' Urr)
Supervisor License Number ~J ]. (/0 ,- 5
Expiration Date 10 - / . C.' /.1
COllslr. Contr. Number
4JCJ<P
. cn - 0 .:\
Expiration Date ~:J
1 J_
Owners Na'J'9 G 1((iJxAYi ];n V' .
Address r 0,80><-' 7/1
c.~~'nCPUd Phone
OWNER I~ALLATI()N
The installation is being 11IClde on property I own which
is nol intended for sale, lease or rent.
Owners Signature:
Inspection ({equesl' 726-3769
Service Included
$106,00
$ 19,00
r;;:.#-"t... ,-,:!t~'~;""l"P'!"f'"'(1l"'1';"."t';'lF:~-T1~":'-.~""'t"~'#"\;"'~ t.,-,,.~
C. l!iTeinporni-" Services ofli'eNlerS",,~~:~~;li~ _ ";l;l '~i~~r-P:' 'l:~ ::.~;~~:\~!~ ttif!,
i.<' .t,~"..,\ ~"~ ':~", ,'. lh'~'~~ !(' ,>~ . ~~ ,~;..: -lt4Im",f4't'h\~~t ,~:f'~ ,1~.~~1~~#i!j;,~
Installation, Alteration or Relocation
200 Amps or less
20 I Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100,00
Over 600 Amps or 1000 Volts see "B" above,
D ~I)l;''' ;:;:17"'T1 'Cl:-: 'r--"l-: '~~i?'~::~f;f{i"r'i;:..jt,';::1i\,~"~;\-:::rt;~/'~rn;"''';t?>f'~":W' !~,' t1i',':lii:~;,Y1\"n
. ')1 anc 1 II ~Ults '~1~~1'1..~\' '.I\,.I.'i."..;i,1J:-.:t~,:' ",<,'hN",it; .llt"....V l t~l~~". t tll.'.rl
;"'" ",{...,. ".' ~''!:....',:_,;j\..'\~''~ '.' .,.....,,;....,',_:..;'!."Il''''->t'~. ..-..I.,:l'!.c.'."/J
New Alteration or Extension I){'r Panel
One Circuit
ea~h-Additianal Circuit or with
Service or F ceder Pennit
$ 43,00
$ 3,00
E. t~~ I\1~~~fi~I;~li~'Ts~i61~i;f~;t1~i~if~'f:f~'~j\la~(i)f~E~;~h7"'i;t~i'i~ti6fi~
"'i-:"I/'": ~r,"<lJ ""At".' "; , ';""~",'ll..'1"";" t;"'../ "..h"'".",....1...._;,+"";~.. ,~",,,,~,, .". J'.~.,.'....",."'"j. .~.'"1'tt...,...,.
. '. ._'.~'.,....._.".",..""'.."..'_,,,..:...'--" .<..;,_~~..'".'..,""',.~'.~..,,',,,.,'h',.'..
Pump or in.igation
Sign/Outline Lighting
Limited Energy/Residential
Limited Encrgy/Colnmcrcial
$ 50,00
$ 50,00
$ 25,00
$ 45,00
I\linimum Electrie Permit Inspection Fee is $45.00 + Surcharges
~..;c-r:'rP".""'i',~,.".t+;nT~\-,' .':'J.--r;-~I~~~,1:' ~~~'!~r~~ ~
4. ''SUBTOTAL'OF ABO,VEq --', ,~' if" Po u ~
.}1f{\~j.";':m~~rt:ttt~~h;'!:~:~cs~~rd&;e:'rl'J"": ;:~~ (t? ~ ~
0.3()
q.lff
C/J7~"L
7% State Surcharge
I 0% Administrative Fee
TOTAL
Shared Dri\'c{T:)fBuilding Fonn.c;/Electrical Permit Application I-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 189
ELE2003-00 189
ELE2003-00 189
Paymenls:
Type of Payment
CredilCard
Description
Perm ServIFdr 200 amps or less
+ 10% Administralive Fee
+ 7% Stale Surcharge
Paid By
BUILDERS ELECTRIC
'''.~"........ '
IItr=-~-,','--," --',", .', ,i,."
"".""""-'...... 1
. ,
.".""",,,,,_ .~.'......"i #~-". .-
Receipt #: 2200200000000001387
Received By
njm
Check Number
Batch Number Authorization Number
000141 061329
City of Springfield Official Receip'~
Development Services Department
Public Works Department~
Date: 08/13/2003 2:16:40PM
Amount Paid'
Item Tolal:
63.00
6.30
4.41
$73,71 .
How Received
In Person
Payment Total:
Amount Paid
$73.71
$73.71 .
.
.