HomeMy WebLinkAboutPermit Electrical 2003-6-19
, bmitted has the following
c:, - 18,- 0 ~e following proJect as su uire specific land use
zonrng:-and does not req
COMPLEI'tff}.'I)1!i:<;CHliVULE BIllJ:I'~' (l9. -
'2onlO9'- ~-,q-02
Date - c:t<.vJ '
A. New Residl<~li1/,\-ize'iiIfl!!JtI2lD~I..!t: r _...;;, per o\\,e)ling unit.
Service Included "*
1000sq, ft. or less $106,00
Each additional 500 sq, ft. or
portion thereof $ 19,00
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
i"-
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~'":."<:''''!;:':' '-:CITY,OP"RINGFIELD':OREGON, ," - ,)
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54l)726-3753 . FAX: (541)726-3689
ELECTRICAL PERMIT APPLICA TION
City Job Number B-tz.oo3-DO {4 g Date
I.
LOCA110N OF INSTALLATION
3,
13Ql.,?
MA--/rV ST
LEGAL DESCRIPTION
i 70'3 ;,b) L
JOB DESCRIPTION
Atw S.AP, -PIINtL f 1 CJ{T- SwY!E.t
63 S-O(
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days,
$50,00
2,
CONTRACTOR INSTALLA TION ONLY
B. Services or Feeders - Installation, Alterations or Rclocathin:
200 Amps or less
20 I Amps to 400 AI~
40 I Amps tO~~~l[<),,\
60 I ~~'<<tJ ~~~,p,
PIll'ne ( 54 1 ) 4 6 1 - 0 2 9 1 ~~iR [.D~[ ~I\)'~~~'
~ S\\~\~<'&.~~~~~hK-
~~'\\~ <:c.~~~ ~~'IJ\:. ~~~ -
Supcn'isor License Number 34 85-5 "\~~~~~~~ ~'i;.~<S'UlipOrary Srn ices 01 rreden
Expirotion Date 10/01/0 3 <:..Cl~~O:l\) 'IJ'f. Installation, Alteration or Relocation
~~'\ 200 Amps or less
20 I Amps to 400 Amps
40 I Amps 10 600 Amps
Electrical Contractor Beacon Electric
Address 2585 Roosevelt Blvd
City Eugene
CanstI'. Contr. Number
38497
Expiration Dale
01/10/04
Over 600 Amps or 1000 Volts see "8" above.
D. Branch Circuits
Signature or Supervising Electrician
$ 63,00
$ 75,00
$125,00
$163,00
$375,00
S 50,00
~3,co
$ 50,00
$ 69,00
$100,00
New Altenttion or Extension Peli.~allel
.~ Onc Circuit ~eO~\(e~~~\\\\\\J; $ 43,00
Johnsen Each AddttlOnaI:Glrcult,or(.wJth .,o{\/ '2 00
. '\1111\' nU"'''' e\\ $ .. 00 6)
c-: 11 } I All I. -vr7 (,) Service or...Feeder~Penllll_ 0."e S -.... .>. .
OWl r Name ~OU I...tl!i:ID.LO (()J. r ~I \::.\'-l. I \U~~OO?\eo \J ~se (\lIe" p..?- 9ro.t-V; '0,
Add ess 2 On Iq ") tJJ) IlAJ C" :/J:: r!},'~\1/J 'E\le'1\Iiscella;;;'~Us\(sei:n9/feedetl\m inclnded) -Each Installation
, n I 11 I ,"", o..,~. (\ v"'.' O\IJ ". ' , s 0'" ~o(\'"
, i)/,.A. I <1JCO 142 3~/'/I\C~\\O_r),OO\'O. ,.~\o:\ co?\e e \e1e?, \iO(\
Ctty t::,t,l\J r PhoneD - I - 1'1 'Op-?- gP.ump,or I.!1JgattOn-lo\e',\~ i-\o\\\\Ca; $ 50,00
\N ft Cj ~032 i('\ "O.,{Sigl';jq~!!nerei~~'6~g\.l\il\\~ '344~. $ 5000
00'" ," \n'" n{i',9 n"'>'~
OWNER INSTALLATION C~I\I'!':Jmited'Energy'/Restdentlal $ 25,00
, ,.,.t'U\" .i= \..0'
~\l((\iliinited'Ei\'ergy/Commercial $ 45,00
\' \..I.....
Minimum Electric Permit Inspection Fcc is $45.00 + Surcharges
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
4, SUBTOTAL OF ABOVE
7% Stale Surcharge
10% Administrative Fee
Inspectioll Request: 72<1-3769
TOTAL
Shared Dl'iniT.IIAUlldillg F(lllll-:IEI...\.:lrictl Permil ApplicatiplI l-oJ.<h.:
~&'. CO
4, 10 2-
(iy Co 0
'17,22
...., '....
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,:
.
.
City of Springfield
Electrical Permit Attachment
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00148
6/18/2003
6/18/2003
12/18/2003
1396 MAIN ST
1703363203501
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
OWNER! APPLICANT:
PROJECT DESCRIPTION: Add sub panel and 1 circuit
ELECTRICAL CONTRACTOR:
JOHNSEN ELECTRIC INC
2585 ROOSEVELT BLVD
EUGENE OR97402-2500
CCB #~8497 Expiration Date: 01110/2004
j}-
Descriotion Amount Paid "\~<U~~\ Receiot Number
+ 10% Administrative Fee 6,60 ~~..:~ ~\r~003 1200200000000001585
+ 7% State Surcharge 4,62 ~,:~"I; ~~~ S:..q)~r812003 1200200000000001585
Add. Alter. Extend Circ Ea Add 3,00 ~\,\, "\~S ~r::;,~ 0611812003 1200200000000001585
Penn ServlFdr 200 amps or less ..~Q3,O!\ S~,(\~'t- ....'Q"?-~ 0611812003 1200200000000001585
...\'U _,,"" ,~""v ,(' ....
,\S. ~~' ~ - ~'.;:~
To Request an inspection callth~~):.~' lllfl)...:.~~!I, All inspections requested before 7:00 a,m, will be made the same
working day, inspections requeste(ll3~ ~,~fiire made the following working day,
~'f'~~!,r;o..r::;, ,
v- ~ \-
"?-~
SEVEN ELEVEN # 18092-2351
% SOUTHLAND CORP
DALLAS TX 75221
Reouired Insoections:
541-461-0291
1 Rough Electric: Prior to Cover
2 Electric Service: Approval required prior to utility company energizing service,
3 Final Electric: When all electrical work is complete,
By Signature, I state and agree, that I have carefully examined the completed application an!lldo hereby certify that all
information hereon is true and correct, and I further certify that any and all work perlor7.red,shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State of Oregon peii~i~ing't,}'th~. ~lirk described herein. I further
certify that only contractors and employees who are in compliance with.PRS:i~I(055iviII b~'u~-;'d:on this project. I further agree
to ensure that all required inspections are requested at the prop~r_ti~t,!Jllit ~~Zhiaild~~s. iS7ri;~d!!1ile from the street, and that
the approved set of plans, if applicable, wiII remain on the site'at aU,ti;Wes during coristri.ction:\" ~e
\ ,..... S 0.- '\,. OlJ.'u ;t '-"- :'(\OP
jlo.~\O~\j tl)\~ C"t'\~C\Q \~\ o9,e<:. oe \e\e?( c:r;\\o'rl
'" ',0 lJ\)Y ,~c ,,'(\ . -" \
Owner or Contractors Signature ~O'\\'''? 9<:;)1.: ,<}.') o'O\;p,~t~~O'~;\\\\\'l '~~b.~'
,'rI OJ>.: 'lol) I' cet'~ eQ,Ot' n.?>'l:?'';,
r:::l!;i:J. \~e "ot ~;::Y"
Q a,\\\t'Q, \0\ \~~.. <:. ,\,,'0
c :oe\ \e\ \
t'l)~ Ce'rl
Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00l48
ELE2003-00l48
ELE2003-00 148
ELE2003-00 148
Payments:
Type of Payment
Check
lI::'~';:;'''~;''~~''''~",''I'.'
-i~m'" . 0:' t
. +. i
. . .......~.",. ",..'
Receipt #: 1200200000000001585
Description
Perm ServlFdr 200 amps or less
Add, Alter. Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
BEACON ELECTRIC
Received By
djb
L'heck Number
Batch Number Authorization Number
City of Springfield Official Receipt
"
Development Services Department \
Public Works Department
"
Date: 06/1812003 1:26:47PM
Amount Paid
Item Total:
63,00
3.00
6,60
4,62
$77.22
How Received
In Person
Payment Total:
Amount Paid
$77.22
$77.22
.
.