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HomeMy WebLinkAboutPermit Electrical 2003-5-23 225 FiFTH STREET. SPRINGFIELD, OR 97477 . PH:(54l)726-37S3 . 'FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION ..- City Job Nwnbcr a(;""'"i?I5o ') - C5 012.) Date . ~.\',\'_","'~.-i'~,._'~:'"'I..' "J".' ..,.."'"....~...t....... 1. iiWCA110NOJ." iNsTJli;LATION:::.'~<?;r Lf? ;i~'(iJ; ~~ ~;;;-"~'g~':~ U=r.A L DESCRIPTI/1ll\L _ /703 ZbZ3 JOil DESCRIh1'ON 4rirl ~.!J \ \A Permits are non-transferable and expire if work Is not ~tarted within 180 days of Issuance or it work Is Suspended for 180 days. 2. ;;g9~g:4~;W~~!~~:g~~tU Elec:~ C:~~~clo;ri/;J:'"e/~:J'~'~'~ o ZCC> I rr) iT, ~ Address~ Cirj /J J b'J1A '-- -..J 1-&) "J<j SW PhoneS'LJ /-75"4-1, /7/ Supervisor License Number :l6 04- ..3 ~1J?IJ~. :;S Y~~3 ',''ri,,"n',r ".., . '~';;'s' CJ:' OiRnr.ii'.>;:";,;.';;',,,,, :'..:;,::;,::: :'.:'.;:'.i~.:'~'.t::.:;~:~.; 3. y.LU.LY.L.r.LaL:.IE".Jf...r..c.. V~D~YJ".,,,,,,_c,,, .~\:r_..,. ...~~,.. ..'.... .":~""~'..:":.:....'\:..:..,:;,...x":':":_" "'__ .,. .,.:_....... . J"f , :, -,";. ...:.':~ . ", . ..h...II!-~.f\'L...'\='~.. ~ r".' '," r. .:: '.": ,: ..': ,;'.' '~'.. ..ri." "1".' " ':. ~'. . . ...t.: ..... i " '. I'.~'.'" ).': -:.; .... . " :.... ~....,~ ":f'.r'H.c"'.'Y:""-:h;,:~".:' :.i~"<:':~':"':" . A. ~:Ni:1if'ltCSldtniilil';:;Smgle:iii::MUI'ii'''-iinilli'.pel' d;veJllii' ";jjiJit:~Y;:; ~~ .~'...'J'.~' "..:... ...... .'Il......('. ..:. ,.. . '.: '."': ,. . .. . . _". .' ....'...: __~':r;I.~. ~':'~'Il~~._J.... '~':-.' ,r . . 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 c. ~fi~~~~~~~t~ggi~~~~~~;I~~~~~~i~~~~IB]{:~~~~!t~~J~~j~ij~D;~~1r~!;1 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$)00:00{'\\ Expiratioo Date V on - 7 -~ Ov 600A loon"'Irl,\a: .",.':",!l~v Se\\O " ~ er mps or yc.y-o ~ see\"\Q "avOW3 n(\' ~ . ,. '" W..', "'. "" '1\""" ,'CM"''-''''..\'!f ,;,',,"w-<l, ....r,"....""" ''',' '"J. . '" . " D ::, 'D "11" Ti:iH;;:"'" "iTA:~~:y~t~~~:~J;:'A~\T,""L ,-~JoIt1;:l~~r:rti: '';:''Iii:i~I.': ':'-"",,\;',":" " SIgnature of Su. perv n I Irl . ,,;f.'~a. .S~~.,p!,1 ''''',il:t''',!'.!f;:,,1<,.'~~'_<,,:'.' ,~"",,'~~'>;j:<' =""<,,:,,.' ;':.1,;'~",:; . t)"if) ./"j,rr 1/" . () ~ ~~-t~~~~~~;;~~~;6~~~~~\\~e ~;:;a ., "":;'" V .tUtV.G n "T ~uY, ~ . \\)\ One 2ltcwea:\\0~'L-OO" .Q~\a.il'l co~'l."e \E'$~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~,~:: , . \'j . V --I .,;:~-~~ o!:M:*~:tu.:-9."'. .' .\3',u;uz-:......:t!.:..........::t~:.:~ ...;~.~~. .....".....,,~~""-...,....a.\l''''n ..,!:...,.:J 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 . ~~. ---,.".~",..~ "',....'v__"".....,.,.,...,,... .._J'.....~... ,~~.... ~.: ,.... .' ~~., I'." -- / !....-..-'.......~'f'''.... .....'.~l...l\: .".Il!-"',"J..:.,..JI.........:!'\.),........-). rhU'" .......-..--.- 4 ""S' 'i,..'>;Yi~A"r~()-' ,~:.;;.:oOVE' '''':;~.''d;,:;f,<...(;j..~.H'.. .<"'~:U:! 'J .' tlU:.l'\;I;a~ A:'::t1V, .......':1....."~...~ .. ....v , vH: 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 . . ..... 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" ~~ 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 . Page I of I cReccipt.rpt