HomeMy WebLinkAboutPermit Electrical 2008-9-3
SPRINGFIELD C ~-c;.;:?> ZON '~\X..~ \ffi \
" P, "._ :_~ I ~
, , .1' \,--,,,/1'i, "~) INITIALS r."'"" .
",,,,,.,,.',' .Ai;'.;' I DATE ~iI~'~W
"",c .'~' ~ "-':''5 SOURCE ~
ELECTRICAL PI}.RJYIIT APPjoICA TION
City Job Number l.:.rrJ - \'?f1.Jv
Date 8/14/08
:-".....,.... .~~ ;-'-.~. 7C~ ., ,_' "_-,'"'::""-.- - :',:, .~' :,..",..... .':--.,-;;--~, :.", ~~'- "~~"+'-'~~''''.'''~-'''-'-''-''',,:.~-. ,:...-J"~"""'i~ :-;'-.~--
I, ~Pf]S:').110NOIf'IIY~Tj},L0.'!}9IY.lU;;. '__:, 3, :rc;9,M.!'l.:.!!!E F]J..E:.~<::HE.I!.l!IJ.~":Wj/:,91:J1..:'LJ'i;';~'" ~',;:".'::d
1919 Laura Street
Electrical Contractor Olsson Industrial Electric, Inc. 200 Amps or less
201-Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000,Amps
Over 1000 AI'\l~~N olts
Reconnect Of.i\(J17c.
-- -;:-;- ~f.t/S"J):f;' ., , ., ------.. "~,~j
c. i;.~~~e.C~~b~#~~dels~ ,.'. :":r.~:::,:<':t ..;"
InstaUati1>}1. A:lfffi'ti.?;;a,~llt~))
200 Amps or{e\'a D4 D Of? /f? 7ft, 'If?t 1f~'00
201 Amps to 400 Am~,ptf?!. ;SO 4~1 'r;'8 P;.:-IT.~ JMeoU'
401 Amps to 600 Amps OD. ' 'OOA/(,'lfI14f$J URk
Expiration Date 1 /? h / () q D hO !\tar
q~e,; ~O~~~!"ps."~_IOOO Vo~ts see :'B" ~bove. 'It
Signature of Supervising Electrician D. ',.Br~i~c~,CirC.'u-it~. _ ' A:'.: ". ~_
)) I A New Alteratio'n or Extension Per Panel
O~"~ ." ~ / One Circuit ' X..:.. $ 50.00 ~~
Each.Additional Circuit or with I" - $ 5,.00 ~A, 00 lJJ \
~ ~~ ~ f1 . Service OT Feeder Permit ~ ~D'
Owners NaRc . ~ ':::1--0- e~.___.__" _ "... '_._ ~ _ _ r'___ __..,.-,
Address '-!() 4. \~ E. i~ ~lt~sc~~~~~~~~iJ~~~~c.~/f~~~~~!.i~~0e~l) -Eacl;'r,l~siall~!~O~~J
City -c(l'nt-t1P Phone \4,: ~l(()
OWNER INSTALLA:rION
LEGAL DESCRIPTION:
\1b3'l..1 \0 r'l~1...Dl)
JOB DESCRIPTION:
Electrical for new conference room
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Snspended for 180 days,
r''''-:>: r-~ "::-:;"'i{',;""~'_'-""'""":"'.l-< ,~,-.,. "..~~'-""'-'::-""~.. ,::,
2, :/;:QN:rRACT6RI~!?T1~4ATION ~NhY,.,
_ "'_'.___"'-_ ,~_..~__.'.""~._..._'. . l,. ~.___ _
Address 1919 Laura Street
City Sorinafie1d
Phone 541-747-8460
Supervisor License Number 3334 S
Expiration Date 10 /01 /09
Constr. ContI. Number 63473
The installation is being made .onproperty 'I own which
is not -intended for sal~J lease or rent.
Owners Signature:
"1Ii:::l11.Y.I: ~:egQn h,w rAnulres you,t,o
follow rules adopted by the Oregon Ulility
Notification Center, Those rUh'eosAa~ 9S;~_~~~
.",,~q~?_nl'l1_n~~ 0 throug
Inspecnu nest: '726-3, :9',n copies of the rules by
0090, au may 0 a
call'ng the center, (Note: the telephone
: er tOI. th^ nregr"l lJ.tiiitll NotificatIOn
nurn;) a ~ "" - . ,
, Cp\'''''r i"i .80U.8:12.23~4),
J....-' v
'- ...,.,.-U'~:'7r::,--..l';'ir"')'-.,"""-'--'r~-::- )'-"-:-:--r-::~ ,:.,",--. "-"-.,..~ ","'---:q
A. ~ N'ew Rcsidcritii~1 ::"~in.gl("o!'iMu,lti-F~lIni!y,,'pcr.,'''d,,'clling!llnit.:'
.. ,;,! -"".-. ". - . ....,-.'. " . - ,
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
$121.00
$ 22.00
$57,00
r-;-:-"'''':-:;;;::'':~j''~' .r" '..'_. ',,' .~,;<, " _'.. -:-:-r- J '.. '_ ".- :.... .-.. i
B, ; Scnriccs;or-Fcc"ders ";'InstanatiOJ1; Alterations or Relocation:'"
,;.. -"" _.....::.,;....:...:"~-_.. ...;,.~ ......-- - "
5
$ 73.00
$ 86,00
$143,00
$186.00
$426,00
$ 57,00
365,00
Pump or irrigation $ 57.00
Sign/Outline Lighting $ 57.00
Limited EnergylResidential $ 29.00
"Limited Energy/Commercial $ 52.00
Minimum Electric Permit Inspection Fce is $52.00 + Surcharges
4, L~~~~~;~~~!;~q.Mi.fi:Y2A5 ,tP:; 1~~ i~
IO~o AdrnmlstratI~e Fee "A"'"'\ AQ 4 _ 0
5% Technology:F"e, ' ~ \.-:\ . ' O'Q.
TOTAL" .": 'OCL~'i'iR RO"\
Shared Drive(T:)lBuilding FOrmS!Ele~"'I.Pe PPlicat~on 7-08.doc
~t.~ OY
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
"
Job/Journal Number
COM2008-01322
COM2008-0 1322
COM2008-0 1322
COM2008-0 1322
COM2008-0 1322
Payments:
Type of Payment
CreditCard.
cReceintl
RECEIPT #:
Description
Penn Serv/Fdr 200 amps or less'
Add, Alter, Extend Circ.Ea Add
+ 5% Technology Fee
+ 12o/~ State Surcharge
+ 10% Administrative Fee
Paid By
. OLSSON OFFICE
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200800000000001322
Date: 09/04/2008
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
IIh
00360 Phone
Payment Total:
Page I of 1
7:44:26AM
Amount Due
365,00
30,00
19,75
47.40
39,50
$5U1.65
Amount Paid
$501.65
$501.65
9/4/2008