HomeMy WebLinkAboutPermit Electrical 2003-7-16
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06/06/03
CITY OF SPRINGFIELD
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225 FIFTH STREET 0 SPRINGFIELD, OR 97477 0 PH:(541)726-3753 0 FAX: \:>41)/~o-~"", (, (l- "II, 'l,,' . aleo
ELECTRICAL PERMIT APPliCATION. \) . 6UIUOZ
City Job Number EtEZo03~OC ibg Dale 7!t5/~3 /) 'leMJdde
I / - . eso PUBI :l!Hoeds 9J!nb9J lOU seap pUB '6U1uoz
1. ~&f0tt9ffi,~f:~~~f4#R~;;~~.~1i,~~;~ 3. tF~!#i~~!~:#.&~~:~m~~:}'li~1~1~~,~$~~J~4.l
1 A07 pi Of'lPpr P;nj~r,;:a" F.t=l.~t
LEGAL DESCRIPTION -j 70 3 Z bZ:S
Shari's Restaurant 0 Z. Lj 0 Z.
JOB DESCRIPTION
A. ;~-~W~t.~.~~$r2~!!~ir?r~~~~~~7~J;~:~t~~~~~~~~~i~%
Permits are non-transferable aflu expire if work is
not started within 180 days of issuance oc if wock i>
Suspended for 180 day'. ,
2. k?B~~~:i~r~3Z~ei~
Servicc Includcd
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thc:reof
Each MauufucI'd Home or
Modular Dwelling Service or
Feeder
S106.00
Install electrical for lottery conversion.
S 19.00
S50.00
B.1~~~~2f~t~~~E~~~~u~~~~1~~~[~~r~~~:f~~,~.~~~{lt~~
Electrical Conlnlctoc Atlas Electrical
Supervisor Lieense Number
2581S
Contracto1200 Amps or less S 63.00
201 Amps to 400 Amps S 75.00
401 Amps to 600 Amps zjt~SI25.00
60\ Amps to 1000 Amps ,\\.I.~ 'l't ,:(\'\$163.00
Ovec 1000 AmpsIVol:>,O\'?-'t. \~ ~\"\ \';) _' S375.00
Reco~nect OnIY~\.\. 't.'r-'~\"i:l ~'t.~\\~ ~\)~. S 50.00
.~~~~~~~~~/i?rf-~Lfrr.\1'~,s;~~3i';~{;(
~~C;;~~~ ~~~~:,.". '---',--<,-" ,,-,-,,--,,~""""-""
'\~~~~~~orReloc.tiOn
~~~~~~
~")ls to 400 Amps
4 1 Amps 10 600 Amps
S 50.00
$ 69,00
S100.00
Address
4403 SE Roethe Road
Milwaukie, Oregon 97267
Phone (503)659-2212'
City
Expiration Date
10/1/04
Constr. Contr. Number
1532
Expiration Date
9/3/03
O.~<:r..?~O ~p.s.<:r.19~~y_~I~_~~::~~_~b.~::~;.."._. ..___ , .
D. ~~~~~f~i~~~~~.!~:f~~l~S{i?~f~f~~~~~%Wi~~~~~~~~~~i~QTai~~~~1i,1s
Signature of Supervising Elecuician
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New Alteration or EJl:teD5ion Per Puel
One Circuit A-" $ 43.00 ..$4'3-:otJ
Each Additional Circuit or with 5
Service or Feeder Petmit ~Oll \0 $' $ 3.00 _$],2-:-00 /
Owners Name Shari's Manaoement Coroq,ration ,". :::;~j=.".t,,!.W~~~S~'ltll~t _,__.-.,,- __.,~..-__...,.. , ,.."..-,
, E. :;"r--:~~"'t;;~~ 9-Y)',,- '~;;iI~~:::Ej\~i{iilst;'ii~tior;",
Address 8205 SW Creekslde Place \\V~""i6~~~~~i~ "~,r::r"'-~--" .',," _-.' "C,''''_' '-.s.
City Beaverton Phone ( 503 ) 605-41r~:\~\I\~i~~~.;:';".&~~u~~ o"~ ~~r--n b, $ 50.00
wiJ' \ n-~~ "n thY!) to ~ \"0 . ~ "
~\'ieQ\ O'~:Ovq!'!!1)iO"'lgn~G9 0 ~O"9 $ 50.00
OWNER INST ALLA TION NO Op.f\ 9!>'€imitai:En~~~~ \e\0~:~\O{l $ 25,00
i{l 'l'ouJ1l~'i,~~d 0 '~~~O\\,,~
!h" in:>tallation is being made 011 property T own whi'i!lOgQ. \~..........gy'/ 81R9"'"""'1AA'. 1 _ $ 45,00 $4~ ()()
IS nOllDtended foe sale. lease or rent .~t~l~~~tI"n Fee is $45.00 + Surcharges
OwnCI> Signature: "\l~\)~~~~~~i~m~~{~t~~f~i~~f;~'~fj _ $lClA-ArT bO
7% Slale Surch:ugc
10% Administrative Fee
~ LJ ZO
J.O".OO- b'" ,
.~70~
Inspection Request. 726-3769
TOTAL
SlJarod Driv.(1WBuilding FOnmlEL:ctriC21 Penni. Applic:ttiou j'()J.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:
ELE2003-00I68
7/15/2003
7/1512003
111512004
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
1807 PIONEER P ARKW A YEAST
1703262302402
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Commercial
PROJECT DESCRIPTION:
Install electrical for lottery conversion
OWNER/APPLICANT:
SHARI'S OF SPRINGFIELD
% SHARIS MNGT CORP
BEA VERTON OR 97008
ELECTRICAL CONTRACTOR:
ATLAS ELECTRICAL CONTRACTORS 003-659-2212
4403 SE ROETHE ROAD
MILWAUKIE OR 97267
CCB # 1532 Expiration Date: 09/03/2003
Descriotion, Amount Paid Date Paid Receint Number
+ 10% Administrative Fee 6.00 07/15/2003 t 20020000000000 1760
+ 7% State Surcharge 4.20 0711 5/2003 1200200000000001760
Add. Alter. Extend Circ Ea Add 15.00 07/15/2003 1200200000000001760
Low Voltage - Commercial Indus 45.00 07/1512003 1200200000000001760
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 InsDections:
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete,
3 Low Voltage: Prior to cover,
By Signature, I state and agree, that I have carefully examined the completed application and do hc~~tu>certify that all
information bereon is true and correct, and I further certify that any and all work performed ~11'ilr.~,\e In accordance with
the Ordinances of the City ofSpringfi~eld d the laws ofthe State of Oregon pertaini!!& t\lith" :o..'tfJ<'de~,l:itled berein. I furthcr
certify that only contractors and empl ;r'ho are in compliance witb ORS 70jc9-S~u..~L~e~cy12lbisJ8ti>ject. I furlbcr agrce
to eusure that all required inspect~' r~'lJuested at tbe propcr time, t~.~'Il ~~~ Ib'(il'ild1.tlt~mGI\,Jl strcct, and that
the approved set of plans, ifaUarfb l!l.~jll remain on the site at.al~J.iUI~ d~$,,~~"l:liA.\'tOI" ~ (U'P 0
0..<(, \~o..~ <.\j'(:- \ \ ~ ~a\!o ~ _\at. ~(OU'tl 0\ ~ /rIO'CI
~\~ ~~~ <.\j' po. ~O~ (~ G0'" ..r'I'\O~ 09\0'" \rtlll~ _a.\\o'fl
~ ,c. ,,~'" '''~ 9o\\o'fl t:" oAJV .... C .",e, ..\raV-
Owner or Contrac~~~1~~~'VV ~o\\,\C ~ 9C!l'U)~i~ 0'0""" \~O\~\\\\\'l ::~,.
~. ~ CO ~\j<(; ~<o '(10111 '-I.Ou'('CI""d$'\0\~0'fl r2;'tyr'
~\j'\f,<~~<.;,.\j ~ \j~~\j\j. \ 009~\\~ \~~t\"a ~ ,\-~()('J'~
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Page I of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
JobfJournal Number
ELE2003-00 168
ELE2003-00 168
ELE2003-00 168
ELE2003-00 168
Payments:
Type of Payment
Check
_,,~.a":,';,,;~ __. ',.'..
1Iit:.' ,
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'.,. at, ,
"- .-' ,,..~,.." '.
Receipt #: 1200200000000001760
Description
Add, Alter, Extend Circ Ea Add
Low Voltage - Commercial Indus
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
ATLAS ELECTRICAL CONTR
Received By
djb
l;beck Number
Batch Number Authorization Number
City of Springfield Official Receipt
Development Services Department.
Public Works Department.
Amount Paid
10:55:03AM j'
,
Date: 07/15/2003
Item Total:
15.00
45.00
6.00
4.20
$7U.ZU
How Received
Amount Paid
In Person
Payment Total:
$70.20
$7U.ZU
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