HomeMy WebLinkAboutPermit Electrical 2003-5-21
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, ~ CITY OF Sl)NGFIELD, OREGON \..~~
fie ftA5301
225 FIFTH STREET, . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ,..'1...
ELECTRJCALfERMITAPPUCATION ~ ~~'V-I
City Job Nwnber i::;..l.,E. 2n:::P> -OQ3t{vate li - ~/- 0 ~ s' W
I. :: L(RpArrqrf!fJ},:ri.~fAL,lJ.'l'IQl'l:. o:~;:"',J 3. r;s"ifJJi!.!li/ii{~!}SC1ffll}CJIJ?: BELQW:~;, --~- _.. ..._
3 j '7 k L Jf: I>'Jc71 /1 ~,r
Installation, Alteration or Relocation
200 Amps or less $ 50.00
20.q lliji!>€w:400 Amps . _. HR:~O
40'11\'E1lS~91~QI1.AlnpsLL EXPIRt Ir 1m: y.$'t:~:bo
<;~~~o.t~~~~~~YOO~~~AmMa'~~yk.S; I,
D. . 'Bl'llllcli '-llrcults 11.. ' . '. ". . ,
~e~ti~JA1;;p"A.;..'~~f.~~~;p:r~:ne~- -- ._--W..
One Circuit I $ 43.00 43 ~
Each Additional Circuit or with
OwnersNam~ i'1\&lcoko~~ se~i:,.or,:ee~::pe:it., ". .... .."~:~.~~:~.."",.,:,,
Address ?-,W)....g ("{"l\ o. f'\, E.. ~~cena_neous.(~e~ice/feede~_itot inclu_~ed)-"Ea~'I~~tallation
City ~ Cft IL \Tf Ph~ne Pump or irrigation $ 50.00
--------cs-- Sign/Outline Lighting $ 50.00
OWNER INSTALLATION Limited EnergylResidential $ 25.00
Limited Energy/Commercial $ 45.00
LEGAL DESCRIPTION
\ '70~ "'C\~\
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JOB DESCRIPTION
y,v::r/JII 11/~ ~ne1
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
_.~ '--',- - -, ---.
2.
CONTRACI'OR INSTALlATION ONLY
"'';'''':''-'''~: _.~ "-,,"', -. _. _..~_,..;,,;;;. ,,"":.,i ,.,~~....~
Electrical Contractor
L . if, J1IIJ14?t5 Ew:.r
Address
4&'3
<;;r
("H eLu;.....
City
C,f'FO-
Phone ""747-0!i; 1/
Supervisor License Number
414-'5' -5
~..,-L .~
-0'1-
Expiration Date
10
Constr. Contr. Number
() I f13 3t'J
Expiration Date
(;-8 - 05
Signature of Supervising Electrician
~ ~
--/~ 2, ~
The installation is being made on property I own which
is not intended for sale. lease or rent.
Owners Signature:
Inspection Request: 726-3769
~
t-~....,..."" ~.' ....._~... ", '_ . ~-:.~. - ":' .....";.. t --
A. ~.Ne~(~~idential:;:-Singleor Multi-Famjly:perdwelling unit.
~ -<- ~._~_.._~.,,-
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof $ 19.00
. Each Manufact'd Home Of ' reqU\lt:3 yoU.\O
Modularpwelling:Se&ice 8}W" Oregon UW,I$'V50 00
.-r.l~h"V'-- dbyl"e "'c'
Feeaer \ s adopte \ s ell" ~V' ."
foll~)N ~,U'~r.t.;l'lter', ::r.nosar~~. I'Q<J5-2-\.W1 . .-.
Bi\j(,~~r.vI~,;Slor'Fee~e'Jr..:l~~taUatio9; Xlterat!2,!s\Or ,R~locnti~n:
"W9S2.-0IHU .. . ""-"'esntH\~,J.W;.._. .---- ...' . ."
in 0/10. "_d """y obtain cop' etelepnone
~90-J1lPs.or less nter ~Note: tn"'(,M~!l.o
201 ~PS\foI400c;mpSr~gon UtilitY I"~~'" $ 75.00
40IrAmi>s'lo600t~~~1_800-332-;!""'~" $125.00
Cp.ntel."
601 Amps to 1000 Amps $163.00
Over 1000 AmpsIVolts $375.00
Reconnect Only $ 50.00
$106.00
: .:.-.--_~:~-. _. ,. ".-:-,-'--"r .-.-,-. _. -.
c. ,;Tempor~ry;Seryii:e.s or Feeders' ',,: i, ,>,.;.. " . i
I.........."....".. ;<j..."_."'-....J....,,"'~,_"''''..'"''. ," ..,_.............~"r..:...',.'.".; ~ ..., c.____.,._....:..r........_""'..._...... '" '''' .
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
;,.,_, ':'~ r',~--;;: ~~':--:;- ~ .
4.SUBTOTALOF;,ABOVE' ..
;~_<:""':;;".-"~ _~;:G_:;j:~.~ _' ~_ c .:.::._: .
__. ._ . __.: I.f~ -43 ".:!<'
315 -; .::(
'Iso "\ 0"
5Z b~ 5() 3..L
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building FonnslElectricnl Penn it Application l-OJ.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 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00134
5/22/2003
5/22/2003
11/22/2003
SITE ADDRESS: 329 MAIN ST
ASSESSOR'S PARCEL NO.: 1703353112300
PRomCT DESCRIPTION: Inslall new oullel
. Springfield
TYPE OF WORK: New. u 'U
T 0 ... .. >'. . l.1If "" vU .
ATTEN I N:T-YPElOFtJSE:"" Commercial
. follow rules adopted by the Oregon U\lIIlY
.._""~otinn r.p.nler. Those rules are set forti
iEr;El6T:RI~~i;~(i)NTIDfctOR: l.1<:l'" -VV b
rl" Vn.1I m~y nnn:un (;U..,It;;:, VI Ul'-" rules ')
~CH M.oRRI~__E];.~.CTRIClole' the telep5.4.l',7.47-081 1
483:SI!fEGI!EYSr-'ler.\" '.. ..'
SP.RINGF.IEIlO\GRle7477n Ultilly Noltflcatlon
CCB # 0Ise~ntell?1!P,i~tion.Diile:206/08/2005
OWNER/APPLICANT:
MILLSTREAM PROPERTIES LLC
380 E MAIN BLDG B 2ND FLR
MIDWAY UT 84049
Descriolion
+ 10% Administrative Fee
+ 7% Slale Surcharge
Add. Alter. Exlend Circ
Minimum! Adjustmenl Electrical
Amounl Paid
Dale Paid
Receiol Number
4.50
3.15
43.00
2.00
OS/22/2003
OS/22/2003
OS/22/2003
OS/22/2003
2200200000000000911
2200200000000000911
2200200000000000911
2200200000000000911
To Requesl an inspeclion call the 24 hour recording at 726-3769'J All.jysl?'<clions requested before 7:00 a.m. will be made the same
working day, inspections requested after 7:00 a.m. will be made~hl!fulroWing working day.
1 HIS PERMIT SHALL tXPIRE IF THE WORK
MU I nUNILtU UI~UtK 1 KI:> t'tKMII I::> NU I
COMMENCEO OH IS ABANDONED FOR
ANY 180 DAY PERIOD.
Reuuired Insnections:
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
By Signa lure, I slale and agree, Ihal I have carefully examined Ihe compleled applicalion and do hereby certify Ihal all
information hereon is Irue and correct, and I further certify Ihal any and all work performed shall be done in accordance wilh
Ihe Ordinances of the City of Springfield and Ihe laws of Ihe Slale of Oregon pertaining 10 Ihe work descrihed herein. I furlher
certify Ihal only conlraclors and employees who are in compliance wllh ORS 701.055 will be used on Ihis project. I furlher agree
10 ensure Ihat all required inspeclions are requesled allhe proper lime, that each address Is readable from Ihe slreel, and Ihal
Ihe approved sel of plans, If applicable, wIIJ remain on Ihe sile al all limes during conslruclion.
Owner or Contractors Signature
Date
Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield
Development Services Department
Public Works Department,:
Official Receipt
Job/Journal Number
ELE2003-00 134
ELE2003-00 134
ELE2003-00 134
ELE2003-00 134
Payments:
Type or Payment
Check
Cash
Job/Journal Number
ELE2003-00 134
ELE2003-00 134
ELE2003-00 134
ELE2003-00134
Payments:
Type or Payment
Check
Cash
5/22/2003
Receipt #: 2200200000000000911
Description
Add. Alter, Extend Circ
Minimwnl Adjustment Electrical
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
L.H. MORRIS ELECLTRIC INC
L.H. MORRIS ELECTRIC INC
Received tly
ddk
ddk
Description
Add. Alter, Extend Circ
Minimwnl Adjustment Electrical
+ 10% Administrative Fee
+ 7% State Surcharge
Paid 8y
L.H. MORRIS ELECL TRIC INC
L.H. MORRIS ELECTRIC INC
Received 8y
ddk
ddk
1:32:04PM
Date: OS/22/2003
Item Total:
Amount Paid
43.00
2.00
4.50
3.15
$52.65
{;beck Number Confirm No
.
How Received
In Person
In Person
Payment Total:
Amount Paid
102540
50.31
2.34
$52.65
Item Total:
Amount Paid
43.00
2.00
4.50
3.15
$52.65
Check Number Confirm No
How Received
In Person
In Person
Payment Total:
Amount Paid
102540
50.31
2.34
$52.65
.
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cReccipt.rpl