HomeMy WebLinkAboutPermit Electrical 2003-2-18
1. LOCATIO!,! OF INSTALLATION ,"II
/8791 flOV/(t' Y fk !UIA F-. _ A: New R~il1e'ift1'lll-Slngle or
) .\\.0 "",s'c MilI'if-Family per dwelling unit.
:o1fl' eC\\ .
eS s\} "le!;oQ Service
o z.. '?ot ~~\~~a\ ,.<I"'
\o\\O~'(:;; OOl:P
~"e e.{\
J~ DESCJUPTION vp'''\,,\
-/jJ 1 ~ I a.Y mum a~~,a 1-0","11
Permits are non-transferable and exIW.!\. '=>'11"0"".
if work is not started within 180 days """,e"
of issuance or if work is suspended fof"<
180 days.
~~A.AA~
Owners Nam; YA,-y ~'c.,~' '-- ~;wB;~::a~;~r:ru~~tension Per Panel
Address /63 I IJIIJt"Z5r ~<L . rE~'\'1Gjr.Rl!i~e90n law reqUires ~~~i~i~y1i43.00 _
V / C A AT ul s adopted by the Ore~o~ c::p.llortl'
City I c;.tr>. IJ.. Phon~c5fo\lOWHacW Adffitwnal'~uit'o~3NithfServit'bn.1
. NotiIiC!l1l<F?e'dff llWih through OAR 952- -$ 3.00
OWNER INSTALLATION inOAR952-~ 1- ~~incopieso1thermesO"Y -
The installation is being made on 0090. \E)llVli~~lilI!,e~us (Ser.v!!,\~r!lid~i'hio'ilfneluded)
I hi h. . d d \I'~"""''''~ ~"r.IIP, ""'\"0. '1' t',on
property own w c IS not mten e ca h~n:msta atlOn Utility Nott Ica
for sale. lease or renl. numl!/!J1$Jor.'iiTirafi~~0~332_2344). _ $50.00_
Sig@'~tline:'L1glililig _ $50.00_
Limited EnergylRes $25.00
Limited Energy/Comm I $45.00 45 00
.
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
LEGAL DESCRIPTION
_i70'3 Z6Z:s
2. CONTRACTOR INST ALLA nON ONLY
Electrical Contractor ADT Su.ur- .. ty
Address 2~ I ~ SIJI?~!:! Of".
City. Bl!/lIle.dOl/\
PholleS03. Ii"- 7/00
Supervisor License Nwnber
:zgq Lx A-
Expiration Date
It) ~ 1- O~..-
Constr Contr. Nwnber S't 4f 4'1
Expiration Date
5- 7- 05
Signature or Supervising Electrician
Owners Signature:
.v~+OlV\er# 2-83-035oo-01/CZ
ELECTRICAL PERMIT APPLICATION
City Job Number..E:u;.~ZOO3. ...0'00 Z b
3. COMPLETE FEE SCHEDULE BELOW
Items Cost
Sum
sq.ft. s
ac ItionaI 500
sq. ft or portion
thereof
Each Manllf'd Horne or
Modular Dwelling
Service or Feeder
$106.00
$ 19.00
$ 50.00
B. Servlees or Feeders
Installation, Alterations or
Relocation:
200 amps or less $ 63,00
201 amps to 400 amps $ 75.00
401 amps to 600 amps $125,00
601 amps to 1000 amps $163.00
Over 1000 amps/volts $375.00
Reconnect Only woAA- $ 50.00
I-\OilCE' ~~IRE IF 'THE,. -
S pt.~lA\I[e/il\l~a~y: e ~1~\qrJN'i<Wet~O
1\1\ o~nft'Ultfjjl,!1fJiJ ,t1\l!l)~~~~lon
p,\)1\1 \ 1=1 OR IS ABM~UU
COMME2llO~~~~\\<;1~
I\N'i 1MDij)~~0 Ji'Oo~mps -
Over 401 to 600 amps
Over 600 amps or 1000 volts see
"Btt above
$50.00
$69.00
$100.00
Minimum Electric Perlnlt Inspection Fee Is $45.00 +
Surcharges
4. SUBTOTAL O~' ABOVE
7% State Surcharge
(01'. Administrative Fee
4S.00
~
5 a.bS
TOTAL
.
.
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:
ELE2003-00026
2/4/2003
2/4/2003
8/4/2003
SITE ADDRESS: 1829 PIONEER P ARKW A YEAST
ASSESSOR'S PARCEL NO.: 1703262302301
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Commercial
PROJECT DESCRIPTION:
Security system
OWNER! APPLICANT:
PAN PACIFIC RETAIL PROP INC
1631-B S MELROSE DR
VISTA CA 92083
ELECTRICAL CONTRAcrOR:
ADT SECURITY SERVICES INC 541-736.4973
PO BOX 5035
BOCA RATON FL33431
CCB # 59944 Expiration Date: 05/07/2005
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
4.50
3,15
45.00
02/04/2003
02/04/2003
02/04/2003
1200200000000000648
1200200000000000648
1200200000000000648
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 the following working day,
Reouired Insoections:
1 Low Voltage: Prior to cover.
By Signature, I slate and agree, that I have carefully examined the completed applieation and do hereby certify that all
information hereon is true and correct, and I further certify that any and an 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 described herein. I
further certify that ouly contractors and employees who are in compliance with ORS 701.055 will be1used on this project I
further agree to ensure that an required inspections are requested at the proll.lllJtime,'tIiallea'Cii lilllir8s is readable from the
dh h cd fl 'f I' bl .11......""'ulli".J!o1:j.aI..;.. ...,..._~I'~lIli"I\l .
street, an t at t e approv set 0 pans, I app Ica e, WI 'remam on !lSlte!!'t . "mes.uur.ng construction.
10\loW rules a "I." U ~ lS~'r'U\eS are set fortr
Notification cent~~.:.h.~__..~h nAR 952-001'
Owner or Contractor.; Signature O'r-'t.. in OAR 952-ul[jai'e'~' ': '~;pies 01 the rules Oy
,\,\t. 'l'l ~ 0090. you may 00 alO te' the telephone
~. \. t.'1-'i'\'r-t. ~'r-~\' \S ~O calling the cen6r. ~~~ Utility Notilication
~Q1\~t.~~\' S\'\~\'r- '\'\\~~o~t.\) ~Q'r- number~~~~:~iS ~~800-332-2344).
,\,\\S \'\O'r-\lt.O \) O'r- \S t>.'O~
t>.\)i ~'t.~c,'t.\) 't.'r-\O\)'
c,O\-l\ '00 Ot>.'l 'i'
t>.~'l \
1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00026
ELE2003-00026
ELE2003-00026
Payments:
Tl1'e of Payment
Check
Paid By
ADT
Description
Receipt #: 1200200000000000648
Date: 02/04/2003
Low Voltage - Commercial Indus
+ 10% Administrative Fee
+ 7% State Surcharge
Received By
Cheek Number ContirmNo
djb
Page 1 of I
2/4/2003 \
I :50:25PM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
.
Amount Paid
45.00
4.50
3.15
Line Item Total:
$52.65
How Received
Amount Paid
In Person
52.65
$52.65
.
Payment Total:
cRccciplrpt