HomeMy WebLinkAboutPermit Electrical 2003-5-6
. ~ ..
,~ CITY OF ~,>--"UNGFIELD, OREGON , () ,.. "
bmitted has the following
11.1equire specific land use
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: t~!ifj~~!fbM'I
ELECTRICAL PERMIT APPLICATION ."~ru,.' Zoning (r ~ (L
City Job Number E~ZCX)3-ci2;J 1/8' Date .~-- G -0 3,,=:" " ,15-I'7-b~
I. LOCA110N OF INSTALLA110N 3. C01l1PLETEl''b''E''SCHEV'dLr.. H1:LOW
200 Amps or less $ 63,00
20 I Amps to 400 Amps $ 75,00
40 I Amps to 600 Amps $125,00
60 I Amps to 1000 Amps $163,00
Over 1000 AmpslVolts $375,00
Reconnect Only ,^u \.V I $ 50,00
_, _ _ _ _. _ . ,(\\},~e'" ~ \)\"~~~ '.
C. Temporary Services,~r.(Feed!'if ",e\ ,.!',
"- - - ,,~;p~ \~e~~",-'3-~~ ~<;'Z:"'"'~ '0)
Installation.;'A:ltcrati;r~ortR~locaijon 0~\)\e 0
\U' ' ~O~\Y -<..~O':O ~,,~ ~ \'1" O~
2~0~'cipsgrlles~0~' ~~OV>'e"'O _,,,Q'I" ,~i.;S<foo
~20 1 Amp'f to'"400 AtflP~ '" CO~\ ,\'(\0 -"-:,,,\\\\C$ 69,00
'\0" ..,n~' - n\'Y '\lo\" :\.0' ,p'
'i!OJ,-impst!.06UUA!yps ~O .",\\\l_"-b.'\' $100,00
'oW' f.! 9'.>" <<\'3-'1 'e~' ~ v .^:t.-~
~~;e/boo.fvmp~~rlOO~Q!l~~~3:B" ,,!,ove, , " _
D. \ Bra~ch,(;i.';hit,~0 . c.....'i'i
\)'"' ~",. ,\Q' '\\....' , - ,
c, ve\-\e. ",
New Alteration,or',Extension Per Panel
~\)' ~
One Circuit
Each Additional Circuit or with
Service or Feeder Permit $ 3,00
E. ~ ~fi~;~I~;n;OUs(S,~r~'ke:~~it~~~~~t~! ~Each In~tall~ion~
Pump or irrigation ~\.. 't.'f..'?~S '?'t.~~~ "'\:)~ $ 50,00 ,
S~~~~\~S!ft\~{)'t.~ \~ ~\:)\:)~.... $ 50,00
'l\'~~~~l~~\~wJt,'Q~ $ 25,00
U~~~4\~~@>hi,?~~' '$ 45,00 ~ \
3'J
7% State Surcharge
10% Administrative Fee "{..)""O
'TOTAL sz!;E
yen(ao MA-ltJ S+, sfu.3.iO
LEGAL DESCRIPTION ,~\>I=I..-I:> "1747 &'
SEC.<..JFlIT\.1 ~ SYSTE'"..vf
JOB DESCRIPTION i70L3Z'iZ oo=D
Low
"ol-i-A I ~
Permits are non-transfcra'le and expire if work is
not started within 180 days of issuance or if \\-'ork is
Suspended for 180 days.
2.
CONTRACTOR INSTALLATION ONLY
Electrical Contractor A-pQ.l< S" ~ ~ S
Address ~.d '3 S, 4l.j Y-:!o S-J..
City <?t=" t....l>
Phone 7f.(Y-~1.f ,
Supervisor License Numbe~ - '10 ( C e. P
Expiration Date
/0-/-03
Expiration Date
/CJ'();)- g:> 3
10 -/ - c) S-
Constr. Contr, Number
Signature of Supervising Electrician
?~.~\,.
OwnersNam~resT ?r-cduc.\s ~()'Otto..rc.~
Address i4S- Gz:o.,~dv11<.~ ^-/7~
City ev::1' Phone 'f 'i L./ ~ Of g '3
OWNER INSTALLATION
The installation is being made on property 1 own which
is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
A. New Residcntial- Single or j\'lulti-Family per dwrlling unit
Service Included
1000 sq, ft. or less
Each additional 500 sq, ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106,00
$ 19,00
$50,00
B. ' Service~ or Feeders - Installation, Alterations or Relocntion:
$ 43,00
Shared Drivc(T;)/Building Forms/Electrical PI..'ITllit Application I-03,doc
".-
4
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Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS:
ASSESSOR'S PARCEL NO,:
PROJECT DESCRIPTION:
OWNER! APPLICANT:
HYLAND BUSINESS PARK LLC
PO BOX 7867
EUGENE OR 97401
.Descriotio"
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltaee - Commercial Indus
.
.
City of Springfield
Electrical Permit Attachment
PERMIT NO,:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00118
5/6/2003
5/6/2003
1116/2003
4660 MAIN ST Ste 320
1702324200200
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
Low voltage
ELECTRICAL CONTRACTOR:
APEX SYSTEMS INC 541-744-8949
623 S 44TH STREET
SPRINGFIELD OR 97478
CCB # 100283 Expiration Date: 05/13/2004
Amount Paid
Date Paid
Receint Number
4,50
3,15
45,00
05106/2003
05106/2003
05106/2003
1200200000000001139
1200200000000001139
1200200000000001139
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.$e following working day,
.OV.,~"\ _,
e"<J . '0- ,0-
Reouired Insoections: ,:S~ O~ e.... s:p"
eO'; e<:$ e? ~ '0'
1 Low Voltage: Prior to cover. 1>~ ~ e O~ s 'Ifio ~ C!J<; .s.e"" e
,,~" .'S' ..s.e ()'i>' ._e ~ ",o<::',,,~
By Signature, 1 state and agree, that 1 hav'b~refiilly~xa~in~:tliel&~'."pJeted application and do hereby certify that all
information hereon is true and correct,.at}d!!;fli'rt/lef :!:.er1ifYJthattiny~aWd all work performed shall be done in accordance with
the Ordinances of the City ofSpril\gfi~ld<l-a~d;!h,~Ws 0!;:jhe'St~te~~i9regon pertaining to the work described herein. 1 further
certify that only contractors and:e'mp'<<Iyee~('~~far~)it~o!h'P.ii~~,With ORS 701.055 will be used on this project. I further agree
h II . d' ,,,"v. ." 'J' "d" '''"h " M": h h dd '. d bl f h h
to ensure t at a require lDSpec!l9nsdl'e requeae a.,t. t l(;:pr~p.er ttme, t at eac a ress IS rea a e rom t e street, and t at
the approved set of plans, if~P.IiliCabl~, ""lIi"reii\ain~gnth~site'at all times during construction. .~\f'\~~
,>0 ,~,v '1l~ "'. v'<r U' !O"" '1''-1 "
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.0 ,"" .0. .,,\ ~~, ,'<;; .,"\ II ~
,. ,",",,' ~,. \. ~' D o\f..v <,<;1-\'" G\l('
Owner or Contractors Signature <:;)" v'li "SJe cJc ate SiS ~"" ~\J'
~v~ ~\.\. '\~\S ~\J~
~\'Vc.;;. ~:0 S~~'VS~ 'r-~'r-~
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Paee 1 of 1
I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00118
ELE2003-00 118
ELE2003-00 118
Payments:
Type of Payment
CreditCard
5/6/2003
City of Springfield
Development Services Department "
Public Works Department.
Official Receipt il
Receipt #: 1200200000000001139
Description
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
Paid By
PETER DESSER
1I:47:53AM
ReceiVed By
djb
Date: 05/06/2003
Amount Paid
Item Total:
4.50
3,15
45,00
$52.65
(:heck Number (;onflrm No
000059 051435
How Received
In Person
Payment Total:
Amount Paid
52,65
$52.65
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cReceipt.rpt