HomeMy WebLinkAboutPermit Electrical 2003-8-18
...
08/07/03 THU 14:48
'.
_______...'9.lI..... _..."..:...__.,ilI........._...
CITY OF SPRINGFIE
_g.
--...-
1i!I00l
..-~-~-.."".
I. ~
-, ' ,...' 118\\'
225 ('" I n SlllEET . SpRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)7~~Il'O~(~.~~8Cii\(; \81\11
ELECTRICAL PERMIT APPUCATION 1\'1el0\\O~::~~e. not lellll (L
Cily Job Number ELEZOO'3-OO/'7D Date cz;h~'J 70n\~~~e\ Q.).J 'iii).
1..:WC4.t!g?H:#:'!.~#:1:1X~!#j!!gp~~;;$ 3. '~\~&~l.~:~~i~',.':~',~:~JY~:;~~;':"""
l1cl~.j~ M.QA~n yt. ' . , " '
I F(Ul ."'''c''''~-_. - A.[~Bi}l;;~~fbj!H#~.~WM@:~1~;y~i~1)~~!l~i.,"'jhi~~~1Gc2~;
\ I 7033 b'3 / () Lf toe) Service Included
. , JOB DESCRlPll0*----V ~ 1000 sq, ft. or less
\ I j Each additional 500 sq. it or
Low vo( i-frs ~ 'I-.:z c.c ~~ -I- poltion thereof
Permits are n~n-transferable and expire if work is Each Manufact'd Home or
not started within 180 day. of issuance or if work i. Modular DWelling Service or
Suspended for 180 day.. Feeder
$106.00
$19.00
$50,00
2. %m~Et~~;~~f~n~S!:!ik~~l B. ;!i~l1t~~I~llE~i~~.~~~t~~i~;~.~;~~i~;~Et~i;~~~;~~i~;~
ElectricalConlracLOt funk I ~ 200 Amps or less' oo,}~~lI.~ $63.00
_ c#-- 201 Amps to 400~'i ~"~\i', $ 75.00
Address <'Ani') C:j-,; d $' 401 Amps to 6pg~p~O~ ",'0\ "I;) $125.00
.....LIL ~'~J"\\V~ 0 a.^ "
B 601 AmR~>tO'IOp.u'AmpS~ ~ ~~ 'I'''' $163.00
City ?JvMcuvl PhDne,~ :;(.~I DlfJ.-l ~iOOO.Aln~sM~'fu:>~ ",'0 \\.'~(\0 A $375.00
. R~n&\t onjA'" PJ"(\ ~ ~. ~" ",~\J' $ 50.00
~,\O' ~,uy ,'\" ~\o-S'e"'O '0\0.!(\v'
~_~ "",'?i: .,~'!i,~",Q~ ,.;;;:R'. ....g" r;~~r, '--- --....-,... ," . ......, ....-
",\ v \.'Ci '''ii'iiD1~:servi~~;Re~!!iiji?:'::',:~'~'.;: 'i~c;';.:.;.''':.:~:;:: '~,~:c'.'.:,
~' ~\. ~~"~,\", \:<>' i;f.""'\j\'''' "6'" '.,",,' "":,.,,, :~,.:-"....::..,..,.":
'O~o. 'b~0,'1:'ij ,oJ 0'0 f?\'~.('\~ n,'1:f'{;
, .,\1\'v '" 01iiStallatiolll''At....atiou'"or Relocation
0'" ~...._,\'. o.v" 0'....- ~\J
'\" O~ ':200 Alfips or'lessv~ $ 50.00
.~ ~ ~. \~' ...,
\ 1;)1;)<1J i~Ol :e.#Ps~.~AmPS $ 69.00
v .~P~IO 600 Amps $100.00
~v'
Over 600 Amps or 1000 Volts see "B" above.
D. ~~i~~~i9ts~~~~]~~?:~['~,~~~~~~~~:~~~~~~J~~~~j1tt~~:~~~~.g'f:~J;.~~t~~~1!
Supervisor License Number :J, d f.." 7 <;,
Expiration Date 10 / I I D t.f
ConSlr, Cc;mtr. Number J, ~q..l0
E,xpiralionDate ~tf.
ising El;~7 -I' / /
~~
Owners Nl!IDe QvJ~" CJ:>lLf'
Addrc:l. 6~O:> Sy~sE fl/y
CiIyC:..J1/6{f!fA,Co':J CO Phone
New Alteration Dr Extcuslo~~ Pane~ ,l"1,f)()
One Circuit ~ ~('j ~'\ I . $ 43.00 .., 7
Each Additi(lnal . \~. W~ '
E.S;;;~~"~~t;i;(fn~hid~i:~:~1i~t~ti~~~
~-'(;. ~S~~yj:2~~/-,..., .", ".... ,."'" "-' ..'"..'.-.i...:..'
""!~'\'\ ,<\.~~t~~~~~1' ' $ 50.00
'\>(..{:> >(..\)~~~~~ghting $ 50,00
OWNER INSTALLATION '?-,\::,'\ ~~~nu~ &ergy/Rcsidential $ 25.00
!he in5tallation is bcing made on property J own which ,,('j ~'I. \~ Enugy/Comroercial I $ 45.00 t/~:
,. not U1tended for...Je. lease or rent. ~uimum Electric Permit Inspection Fee is 545.00 + Surcharges
Own~ Signature: 4.(~~H~!i&~~~rni~~";~ltf:';)jJfii~~;I~~:~[j;~~ ~
blb~
, ~80~
t/OZ~ ~.~J
7% State Surcharge
10% Administrative Foe
Inspection Rcques" 726-3769
TOTAL
Shans:t Orive(T:)IBuildmu FonnslEla=tr1cal Pennir Applicaliot\ l-03.doc
pt2-.0 ~O j
"
.
.
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:
SITE ADDRESS: 1613 MAIN ST
ASSESSOR'S PARCEL NO.: 1703363104800
ELE2003-00190
8/15/2003
8/15/2003
2/15/2004
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Commercial
PROJECT DESCRIPTION:
Low voltage and 1 circuit
OWNER/APPLICANT:
QWEST CORPORATION
6300 S SYRACUSE WAY STE 700
ENGLEWOOD CO 801 I I
ELECTRICAL CONTRACTOR:
,CONTROL CONTRACTORS INC 503-328-1730
1128 POPLAR PL S 503-328-1730
SEATTLE WA 98144
CCB # 63927 Expiration Date: 02/14/2004
'1.0
08/1512003 ~O~ ':\~'l
08/15/2Q.03' \)'1.' O~
08/\tSI2Q03)0~ se'l." 00
^'{,W/I@()03~~e 9~?; s \.
...(\'" .1If.\' \o.'='. 0.. .\0
~'O"'3 ~\,)l \V or~ ,,- f0.'CI
To Request an inspection call the 24 hour recording at 726-3il@, ,~IH~e&ions'reoueSt~d,befor~~:1:':OO a,m. will be made the same
k' d" d ft 700 '1Ib'~ad""'tIf-'~II"-""\)"'rk.':" ~~"'V' ",'I.'
wor 109 ay, mspectlOns requeste a er: a.m. WI" e III ve. e.!o ow!Og wo. mg'\",y, .~\c,U'
,\"" .,~e'i> (",e~\'6"f;:;,-Q.:" c,0~'~."So'" .~o\~
, '/1:.0"" '0" O()\ :0'-'<>' ~v- \)\\\,.. ~r>o-'
Reouired Insnections: '0 .~\c,~\"q,~?; ~~~ 0 ~'-'1/\)0~ ':!J~?;"{.;
1 Rough Electric: ' Prior to Cover ~o"'O~<?o ~ O~ 1(\'0 c,0 '0 O~0 .'000'
2 Final Electric: When all electrical work is tomn~ie..\~~ '" 'O~ >is' o~\s '-
~ ~" ~, ~"
3 Low Voltage: Prior to cover. C, ~'Oe c,e'C'
~-S
By Signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
Information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work~cribed herein. I further
certify that only contractors and employees who are in compliance with ORS 701.055 will be use~D th~ project. I further agree
to ensure that all required Inspections are requested at the proper time, that each address ~~d\'Y\ilHom the street, and that
the approved set of plans, if applicable, will remain on the site at all times during cons~'i{o~~\\ \:l~
\.f$",:~l'("'?:' &,\:l ~
,,,\..\. ~"" ,,,C}~
\~C(;. .t,\\Dll~\)\.'(' ~'?)~\...
..,~'\ f"(,~"'" \) ,'} R-o,S
,... ':(>,S ~ ~1..(\:..\) ~ ~\:l\)'
'\ ~'\':(>~t,\.~\J ~ ~~
\>I ~~~' 'O~ \)
\~",\
DescriDtion
Amount Paid
Date Paid
+ 10% Administrative Fee
+ 7% State Surcharge
Add. Alter. Extend Circ
Low Voltage - Commercial Indus
8,80
6,16
43,00
45,00
Owner or Contractors Signature
Page I of I
Receint Number
1200200000000001965
1200200000000001965
1200200000000001965
1200200000000001965
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 190
ELE2003-00 190
ELE2003-00 190
ELE2003-00 190
Payments:
Type of Payment
CrcditCard
Wi~. C~2:;...'....' .,.,.
%, '. j
_../-".,~" . ~ .I
" . j
,__""_>C. ." .. _.. _._ ,~'~'.'r. .....,
Receipt #: 1200200000000001965
Description
Low Voltage - Commercial Indus
Add, Alter, Extend Circ
+ 10% Administrative Fee
+ 7% State Surcharge
Received By
djb
<':heck Number
Batch Number Authorization Number
Paid By
CONTROLCONTR
000144 030411
City of Springfield -Official Receipt.
Development Services Department \
Public Works Department ,('
.'
Date: 08/15/2003 9:56:51AM
Amount Paid'
Item Total:
45.00
43,00
8,80
6.16
$102.96
How Received
In Person
Payment Total:
Amount Paid
$102,96
$102.96
.
.