HomeMy WebLinkAboutPermit Electrical 2003-5-23
225 FiFTH STREET. SPRINGFIELD, OR 97477 . PH:(54l)726-37S3 . 'FAX: (541)726-3689
ELECTRICAL PERMIT APPLICATION
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City Job Nwnbcr a(;""'"i?I5o ') - C5 012.) Date
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U=r.A L DESCRIPTI/1ll\L
_ /703 ZbZ3
JOil DESCRIh1'ON
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Permits are non-transferable and expire if work Is
not ~tarted within 180 days of Issuance or it work Is
Suspended for 180 days.
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Elec:~ C:~~~clo;ri/;J:'"e/~:J'~'~'~
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Address~
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1-&) "J<j SW
PhoneS'LJ /-75"4-1, /7/
Supervisor License Number :l6 04- ..3
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Service Included
1000 sq. ft. or Jess
Each addiriona1S00 sq. ft. or
portion Thereof
$106.00
$19.00
Each Manufact'd Home or
Modular Dwelling Service or
feeder
$50.00
._~"", ~.'r...-:..: .-".... .. ,,:~.:.'.:-: .... :' '.',..' ..'c,..,~..; .7\'-",: ',' ~" :.;..' ~i~."'.l\:I;::'. ";;:" ~.,:u< ...,:,.:~.." ';. .. .':'\:': :~~:::;:,.~:~
IS. ~:Seriioe.~i1ld:i:~i1cri;::;b1Stliu.tloii;:'Alttrali' ni. 'kJoiaiio,ii';l
';':~'.: ..t;':''":.'~''''.T':';l~'~'I"~,...~:.~t.I~~'f. 'C:..l :.: .-.~;.o(';:' ..:~:<' ,;~:-". c,.,:::,~.~~.~.~~l'L .l\J:'~' ,;}!,,~,:I~~~';:::~'t,:.:'l
200 Amps or 1=
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsIVollS
. .Reconnect Only
$ 63.00 .
$ 75.00
$125.00
. $163.00
$375.00
$ 50.00
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Expiration Dale J 0 - 0 I - 0 Lf lnstallation, Alteration or Relocation
A . I 200 Amps or less $ 50.00
Conslr. Contr, Number 17 7'1 (I") i 20] Amps to 400 Amps 'J~'69~00
- \{,=,07 "."..t
~t / n /\ ""7 401 Amps to 600 Amps \j.J .oo.U 1'I$)00:00{'\\
Expiratioo Date V on - 7 -~ Ov 600A loon"'Irl,\a: .",.':",!l~v Se\\O "
~ er mps or yc.y-o ~ see\"\Q "avOW3 n(\'
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SIgnature of Su. perv n I Irl . ,,;f.'~a. .S~~.,p!,1 ''''',il:t''',!'.!f;:,,1<,.'~~'_<,,:'.' ,~"",,'~~'>;j:<' =""<,,:,,.' ;':.1,;'~",:;
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V .tUtV.G n "T ~uY, ~ . \\)\ One 2ltcwea:\\0~'L-OO" .Q~\a.il'l co~'l."e \E'$~3:00.\i~.:1
. . x.. \"\' .' ~ \'0" Each~A'ddi!ionfJ ~jr"1*.bP~l.l...~U'~ .\\W \,\0'"''
~~. 'iJ.Y1:' )'fft..\\ ~ ServidC'o'r' EeeCler Ptamtel\\~' ^(\ \,)\\ "rS\'3~00
r :::~Nl~ o\C~.J ~~~~~~~ ~ ""E. f~"Mi.~~~~~~~iiJ.~l~t~~r~mji~~li~d;;~i~u~ti~,~::
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Cl!,'0 . '/ -? '3 (., - 'If13 Y Pump or inigation $ 50.00
. f.) ~~ Sign/Outline Lighting S 50,00.
OWNER INST~~ON Limited EnergylResidential $ 25.00
The m.laIIation is being made on,property I own which . Limited Energy/Commercial S 45.00
is not intended for sale, Jease or rent. Minimum Electric Pennit Inspection Fee is $45.00 + Snreharges
, ,
Owners Signature:
Inspection Request: 726-3769 .
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!....-..-'.......~'f'''.... .....'.~l...l\: .".Il!-"',"J..:.,..JI.........:!'\.),........-). rhU'" .......-..--.-
4 ""S' 'i,..'>;Yi~A"r~()-' ,~:.;;.:oOVE' '''':;~.''d;,:;f,<...(;j..~.H'.. .<"'~:U:! 'J
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19,. ~:~._..'-..'...".... ....... '.~. '.,' _ ~ .."-' .... tt':" ,!:'.:..j.:,I'I,r., = .'\ ,l'.(o{' .
..-,"..":',:..*...:wi"..rN::i1!.I":#il~mi::.:..::a.:,.,:;,)~ur:;J_u:;,.~!,(,.~.Iu'; _-,,~'i!,!ftiRO: ..' ,
7% Slate Surcharge '3 r' . :J . 0 I
10% AdmjllistrativeFee ~- L/ ,"30
TOTAL 5 ~."3 / '---
Shared Dri...e(T:)'BuiJdinu Forms'" Ci:lii~cnnit Appllcn#on 1-OJ.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:
ELE2003-00125
5/14/2003
5/14/2003
11/1412003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
1805 PIONEER P ARKW A YEAST
1703262302001
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Add 1 circuit
OWNER/APPLICANT:
T ABA T A F AMIL Y TRUST
PO BOX 943
CARLSBAD CA 92018
ELECTRICAL CONTRACTOR:
M & W ELECTRIC INCORPORATED 541-754-6171
29889 HWY 34SW
ALBANY OR 97321
CCB # 67362 Expiration Date: 06/19/2003
.Descriotion Amount Paid Date Paid Recelnt Numher
+ 10% Administrative Fee 4.50 05/14/2003 1200200000000001191
+ 7% State Surcharge 3.15 05/14/2003 1200200000000001191
Add. Alter, Extend Circ 43.00 05/1 4/2003 1200200000000001191
Minimum/Adjustment Electrical 2.00 05/1 4/2003 1200200000000001191
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 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
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~oile in accordance with
the Ordinances of the City of Springfield and tile laws of the State of Oregon pertaining to thul\'oi'~ld~,s,~r.il.ie~ herein. I further
certify that only contractors and employe~~1ili'are in compliance with ORS 701.055. ~i!1 blPust'hofiothis p,roject. I further agree
to ensure that all required inspectio~"r.e lelJ,l!~ed at the proper time, tha~. ~'fKa1~~s~:ls ~~~g'!!Jle 'i'rQ'n.JJhe street, and that
the approved set of plans, if ap'plicilbl~""'iil'irelDain on the site at all times:dnring.constructioil~O"?- 9'iJf-',^S'0)
O\~'V o,~\\ Cl'l" ,,,,. Q"o" ~O"~ r u\'"
't.iS ,?'t." 'V ~ P- \ \ I;. U\eS ~ ~e~'\ lO'\).~'iI ~ \~e t ne
.,\\..\..\.. -<.~S.",:;\\~'?; 'o\\o\j'Jt'o,~Gell ^~,\O\rI _^ieSO .~1"'{)'il0 M\l\
Owner o{\G.on~-f,l~~~~'a1tir~'O~~v ~o\\~,ca.\~f)!?1it'e " ;'O\i'l'l ~~\e" \~'" ~O\i\WP-
~~\;~;~';.~~\) Cl;'t.tCl\)' \~~::. ~O~ ~:~e~6~~~0~~~~l~AA)'
~\) ~~'?; \)~ Ca.\\\l'I \OI\\"\~.c'\'?>Cl
c,Cl " \OU'\l l'Iu~'Oet Cell\et I"
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Page 1 of I
225 Fifth Street
Spriogfield, Oregon 97477
541-726-3759 Phooe
Job/Journal Number
ELE2003-00125
ELE2003-00 125
ELE2003-00125
ELE2003-00 125
Payments:
Type or Payment
Check
5/1412003
City of Springfield
Development Services Departmeot l'
Public Works Departmeot /:.
Official Receipt. "
,
Receipt #: 1200200000000001191
Description
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Paid By
M & W ELECTRIC INC
2:38:02PM
Received By
djb
Date: 05/14/2003
Amount Paid
Item Total:
4.50
3.15
43.00
2.00
$52.65
Check Number (;onfirm No
.
How Received
In Person
Payment Total:
Amount Paid
52.65
$52.65
.
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cReccipt.rpt