HomeMy WebLinkAboutPermit Electrical 2003-5-21
. ..\;." , CITY OF f-'~INGFJELD, OREGON. '.
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;:;:; 225 FIFTH STREET 0 SPRlNGFIRLD. OR 97477 0 PR:(S4I)726-37S3 0 FAX: (541)726-3689 W~i \. n :.,:; ,.:, .
ELELTJtlCAL PERMIT APPLICATION / '7 ' '" ,
Cil}'JobNumber aEiX:c}, 00 (y) Date s;l ,5/03
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LEGAL DESCRlP110N
nOJZbZ3 02001
JOB DESCRIPTION
P05 Cl:1..h/IA,
Permits are non-transferable aDd ~ire if work Is
not started within 180 days ofiSsuance or irwork is
Suspended for 180 days.
2. ~~C;~1i~llif!1l1
Electrical Contractor Vy",.1 >(cft'L.'c ~Nv~
Address ~'iOY 5uJ f:fUt Auf.
City
P<H1.H"",,\ Ol'l.
'11iNl
Phone $"'<>) - ~-(,771
Supervisor License Number
;)s())' L~p
Expiration Date
10 --OJ -(),J
Constr. Contr, Number
6G7ql
Expiration Date
65'-;;),/- 06
Signature of Supervising Electrician
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Owners Name ~l>A-1I4 ~1l.Y
Address \=>0 &l}C 9~ '3
City ~0',4{)
-
/72.\..LS\
Cl4-Phone
OWNER INSTALLATION
The installation is being made on property I Own which
is not intended for sale, lease or relit.
Owners Signature:
Inspection Request: 726-3769
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Service Included
1000 sq. fl or less $106.00
Each additional 500 sq. ft. or
portion thC!rCof $ 19.00
Each Mauufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. ~~~~~l~~~W;Z'~l~~~~~@rl~!i.fi;~~;i;~~~~~&~~i{~
:w.-.!";;;::;:!..io~......t,:;~.HA't~.;:'..;"".~.,"~'''';:~l:.;.." ..";,~~~~,,~,~R~.~,, ~"~I'...,:..;;.Jt.;'1',...,.,
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200 Amps or less $ 63.00
20 I Amps to 400 Amps $ 75.00
401 Amps to 600 Amps S125,OO
60 I Amps to 1000 Amps $163,00
Over 1000 AmpsIVolrs ~(\~~ $375.00
Reconnect Only ~ '\~\ ,S ~I,)' S 50.00
c. F~lffirl!;:~q~~~:;...;r.-~,. '-'''\'''~~'~' ).;u '~';~~i€&~]:~~~~lH!~[&f.S;f;&fi~~
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~\l"J60~ps ot1ess{:> ~ S 50.00
~~ ~'i'~~40~ ~'s' S 69.00
'\~ OFAr~;~lo,,~\1Ilps SIOO.OO
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r ver6W?Amps or 1000 Volts see "B" above.
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New AlteratioD or ExteDsion Per Panel
One Circuit ~ 43.00
Each Additional Circuit or wi1h IOU': _,I
Service or Feeder Permit . <>." 'l ,,~~3.00
1,\\)0' :\,\..) 1'(1"
f~V\ ..t'\O ~\ \ _.
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Pump or irriglltion'" oo~\e "i,V,ps ~,,(O.'<;o _\ \'I"S'50,06'. ~(\
SignlOutIfu~ugI{'~S(\\et. ~ Cl \'<;o~ ~"Ie" - n \'sq'iJ:oo>\~ .
p..' f\>'\V \....... f\() .~\.!_.. '_\'" ..'''\.''
Limil~~pner~~es!3~nrl~I~\\'-I \.,,\e: '::''1 ~l~'?O
L.rnited ,,~,G /,,/]. .. Q, t.~ 'I' '"$'4-500
1 ....,ergy.'-Ummerc....,\e ,,,{\ _","" .
~..... n!':'" '.JOU \" ce\ ~,~\.2J !'\':"-'
MInimum Eled:rie-Pcrmit'IDs~on Feiill 545.00 + SurchargC.9
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'-t f.:L
. 52. 6'~
7% Stale Surcharge
10% Administrative Fee
TOTAL
Slwed Drivt(I':)IBuildiDg FormsIElc:ctricaI PcnnIt AppliCHrloo I.()JAoc
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Status: Issued
225 Fifth Street
Springfield,Oregort 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
OWNER! APPLICANT:
TABATA FAMILY TRUST
PO BOX 943
CARLSBAD CA 92018
Descrintion,
+ 10% Administrative Fee
+ 7% State Surcharge
Low Voltage - Commercial Indus
.
.
City of Springfield
Electrical Permit Attachment
PERMIT NO,:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00130
5/20/2003
5/19/2003
11/20/2003
1805 PIONEER P ARKW A YEAST
1703262302001
Springfield
TYPE OF WORK:
TYPE OF USE:
New
Commercial
POS cabling
ELECTRICAL CONTRACTOR:
DYNALECTRIC COMPANY 503-226-6771
2904 SW 1ST AVE
PORTLAND OR 97201
CCB # 66793 Expiration Date: OS/21/2006
Amount Paid
Date Paid
Receiot Number
4.50
3.15
45.00
05120/2003
OS/2012003
OS/20/2003
1200200000000001270
1200200000000001270
. ~'i'200200000000001270
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To Request an inspection call the 24 hour recording at 726-3769. All inspections requeste<!\b~f<ge-7:0Q'a~.~.Ji'I!,be made the same
working day, inspections requested after 7:00 a.m. will be made the following working;d;fy.\I'e. '0)'0" ~:' .,' ,,~;Y I)
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..),"'. .\.o~... .,\\'. ,0", .1'"1' ,. ~('~ ':'\t;,')-"
Reoul'red Insuections'. " ,,}u ~,\, ",.....' ", '~,'
~ c'"=' \'-v \\.' 0\ ~v' "r,
. ,\. JI C},' ~~{',r. -~;, ."" ,.~.
1 Low Voltage: Pnor to cover. \A' d~\"\ ,u\' :,\\' \" ~.:::.\ ~'t'\. ,,\~'~~ '~<~,:-'l'
\O~ ,~.,x,,,,~ 0 ..,-:(. r'\":' ."'1,,
By Signature, I state and agree, that I have carefully examined the cC!niji!t,ti'd ap'pilca.!ion',~na'~o.liereby certify that all
information hereon is true and correct, and I further certify that"a~~@nd alnv'o~l<-~~r(oh~e!fshall be done in accordance with
the Ordinances of the City of Springfield and the laws of the State ofOr.egon,pertahii.tg.tolhe work described herein. I further
"'I .~"" ."'" ,'.
certify that only contractors and employees who are in compliance with OR~,\7.ot055:Will be used on this project. I further agree
to ensure that all required inspections are requested at the proper time, th!lt~e~ch ~dress is readable from the street, and that
the approved set of plans, if applicable, will remain on the site at all times during construction.
Owner or Contractors Signature
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Date '0Y.. ~v~\::,"\
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Page I of I
225 Fifth Street
Spriogfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 130
ELE2003-00 130
ELE2003-00 130
Payments:
Type of Payment
Check
512012003
City of Springfield
Developmeot Services Department
Public Works Department ~
Official Receipt 'r-
Receipt #: 1200200000000001270
Description
Low Voltage - Commercial Indus
+ 10% Administrative Fee
+ 7% State Surcharge
Paid 8y
DYNALECTRIC
3:24:09PM
Received Dy
djb
Date: OS/20/2003
Item Total:
Amount Paid
45.00
4.50
3.15
$52.65
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
.
52.65
$52.65
.
Pagelofl
cReceipt.rpt