HomeMy WebLinkAboutPermit Electrical 2003-1-16
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, CITY OF S:__}rnGFIELD, OREGON ()
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)72&,,,16g<Js~ui,a sQac
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ELECTRICAL PERMIT APPLICATION \lIe\OI\O:~o ooaS" ..~ n )
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City Job Number EU-z.oc3- COOL>-> Date - 3-0::<-' '"._,o,e\.. .. ~
<JY' '2.0\,\\(\9
.l 3. I COMPLEtEFEESC~l!E~
\)'0.\.... S\9f\a.~f
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A.I. Ne",Rcsidenti:iI'~.Sin;gleor Millti~F.iAiIyperdwcliing unit. .:.'~
I. I LOCATlONOFINSTALLA110N
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LEGAL DESCRIPTION
176l.333l
C)blO (
JOB DESCRIPTION
F'lTll",d ('~ rC' ,;', ,"-. 1('\ C\ (:(:'; (' ~
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. I CONTRACTOR IN~tAfiAnON();&iY.1
Electrical Contractor .Qlri" tp~F'l pro t~ Inc.
Address 1298 Bethel Drive
City Euger>p
Phone ~L.1-h88-6121
Supervisor License Number
2719S
Expiration Date 10/01101
Constr. Contr. Number 26- 34C
Expiration Date
10101 /01
Signature of Supervising Electrician
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
x
V
$ 19.00
$50.00
B. I Services or Feeders - lristalhition,Atteralions or Reiocation:' J
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
60 I Amps to 1000 Amps
Over 1000 AmpsNolts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
c. I Temporary'Services or Feeders' .
,"
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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 Volls see "B" above.
D.I
/' ~ _ New Alteration or Extension Per Panel
(, ~O rlathan Phi 1 i n<; One Circuit 'J f $ 43.00 L/':I., 00
- Each Additional Circuit or ~~()"'~3
L', . serviceorFeederpt{'\\l"\VI ~.\(\, $ 3.00 9.00
Owners Name .)OV'Y'l"'-. AI)TomoTlvt.- "'.-' ~ t:'I.?\'ri, ;:~~\"\~~,.:,. '''d)'' ".N
Address ~ I ~:') lY\o. __" OS T . \~~. r{~~~o~~jI'~:i;!;\ not mclud~~ Inst:!.llatl()~
, ['.0..11 cr I\\\)'\ t.?-~'i\ -x,~~~-""'- ~'~"~~~(\)'
City c.,~i2\"QC\o\ Phone (rlC;-D90~ ,,\\\\CO\&'q!O'i>df~~~~ .;.~,(0't.~~OO ~(\y
....) t>-\)'\VI 1~~~~'Ming ~o~\ ..'(\0 ~~~\G"'~
OWNER INST ALLA TION c,()~~ ~lS~'lEnergY/ReSi~~~\06'O:C.0~~~~~ ~~ _
The installation is being made on property I own which ~~'( jmited EnerR~~~0(:\~'(\(O~I":~\~?O"
is not intended for sale, lease or rent. Mlnlmnm ElectrR'J.ePJ~!~~li~~~~~~~~~rges
'!",. ..t~'::'~~:0\"~~~~' fiJiP"
Owners Signature, 4.1 SUBTOi..~,,'ii':J~.ji~=w,,',"^O'l!>$'" 5"'" O^
,. , "~0~~.~~~:~~~(~~'=-" 0(. u
7% State surch1lfg~c~~ 0~'O~ ~\(i''i:J 3. (0 l./
10% Administrativ'\K~'O e0 5. ;) 0
Inspection Request: 726-3769 TOTAL ( 0 ('). 'is Lj
U../U /1~
Shared Drive(T:)/Building FormslEloctrical Permit Application J-03.doc
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00003
1/6/2003
1/6/2003
7/6/2003
SITE ADDRESS: 5125 MAIN ST
ASSESSOR'S PARCEL NO.: 1702333206101
Springfield
TYPE OF WORK: Alteration
TYPE OF USE: Commercial
PROJECT DESCRIPTION: Exteud circuits In office
OWNER/APPLICANT:
SAMS AUTOMOTIVE
5125 MAJN ST
SPRINGFIELD OR 97478
541-915-0908
ELECTRICAL CONTRACTOR:
CHRISTENSON ELECTRIC INC 541-688-6121
1631 NW THURMAN 2ND FLR 543-419-3600
PORTLAND OR 97209
CCB # 458 Expiration Date: 05/01/2003
Dese rintion
Amount Paid
Date Paid
Receint Numher
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
5.20
3.64
43.00
9.00
01/06/2003
01/0612003
01/06/2003
01/06/2003
1200200000000000502
1200200000000000502
1200200000000000502
1200200000000000502
To Request an inspection call the 24 hour reoording at 726-3769. All inspections requested before 7:00 am. will be made the same working day,
inspections requested after 7:00 a.m. will be made the following working day.
11l'\9.'t.
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Reouired Insoections: 'j,,'?\~t \T ~\'\ \':1 ~ .
1 RoulWl~~ic: P~~\;~~l\\':I ,?t'?\ x.\) ~Q~
2 ~ E~~~t-\h~lle\ll3~'i}I*~ is complete.
\\,\\'il ,~o..\lt.\) 9. \':11"
By Slgnatur~$tat~.an~liliRe~\l!;OJ have carefully examined the completed application and do hereby certify that all
information /l-~i1S'~'il:fcorrect, and I further certify that any and all work performed shall be done in accordance
with the Ordlil~~'?& Hie City ofSpringlield and the laws of the State of Oregon pertaining to the work described herein. I
further certif~liat only contractors and employees wh'{Clre in compliance with ORS 701.055 will be used on this project I
further agree to ensure that all required inspect~!!'''lill\~uested at the proper time, that each address is readable from the
street, and that the approved set of plans, ifp~~~.\~.j'Ilnain on the site at all times during construction.
~\~~~00~~efla\~""
_,,(1,0 -I~ J"!'.~ _o.~?; .~~
. 'v"-..rt,,.J, . O"'{~ ."...
Owner or Contractors S,gnatur\b\-l;. ~...- i:P9 /(\ p /(\0 ~'" ~e
0~~ \e~~~0t~~\O~0'OO'~e.\'b~-""\O>(\
IX :>tit'" Ce JiS'. \jV~ .~e ~(llY
,o\~~\C~\'~~~~~ o'O\~'~\~~o\~~~;.~",.
~o~~~~ ~ ~~da~\e~o~-;",rev
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225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Numher
ELE2003-00003
ELE2003-00003
ELE2003-00003
ELE2003-00003
Payments:
TWe of Payment
Check
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 1200200000000000502
Date: 01/06/2003
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
PHILIPS ELECTRJC
Received By
Cbeck N umher Confi rot No
djb
Page I of I
1/6/2003 1
2:20:46PM .
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City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
43.00
9.00
5.20
3.64
Line Item Total:
560.84
How Received
Amount Paid
In Person
.
Payment Total:
60.84
560.84
CRcccipt.rpt