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HomeMy WebLinkAboutPermit Electrical 2003-8-29 225 FIFTH STREET . SPRINGFIELD, OR 97477 · PH:(541)726-3753 0 FAX: (541)726-3689 ELEcl KICAL f~IT /V'PLICATION (\ ,,~ \\~ ~ () \ rO-... City Job Numbe, t' L)" O.QL?3 I Date \} 'Ill-" \., ~~ fl to.. ~ I. LOCATIONOFINSTALLAR.'?~_ 3. COMPLETEFEESCHEDU~"IfW V . joOloC[ \t\i.UlJ ~eet) L\~D~(BP~ m\?Jl- ~D~C~ION &.~lD P"mits ~non~ble (n. expke if wo,k " not started With~~r~f::~~ of~ance or if work is Suspended for 180 days. 2. CONTRACTOR INSTALLATION ONLY A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof $106.00 $ 19.00 Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 B. Services or Feeders - Installation, Alterations or Relocation: Electrical Contractor The Murphy Harris CompanyOO Amps orless 20 I Amps to 400 Amps Address 149 9th street 401 Amps to 600 Amps 601 Amps to 1000 Amps City Sprinqfield Phone 736-1292. Over 1000 Amps/Volts '(Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Signature of Supervising Electrician ~.k- (lJ) (\ Noewc~te~ation or Extension Per Panel "- J ()I\~ ~ ne lfCUlt -~. '<:r" )~ Each Additional Circuit or with ""I 01\ (~MI1I'J f\. Service or Feeder Permit Owners Na e ( A . ) I HJe)C-> Address '2JQL2 ~ V Stu G,riCJ.frr #-{la. "Mi~c~Il~~~~~~~S~f~;!~~Jr~~a~:0~~ttif$~~~~d)-Eachlnstallation City \(..e dIV\.6n.d Phone Pump or irrigation $ 50.00 Sign/Outline Lighting $ 50.00 Limited Energy/Residential $ 25.00 Limited Energy/Commercial $ 45.00 Supervisor License Number 'Yoqq S t lJ I ) Dq Expiration Date Constr. Contr. Number 20-474 C l 0 l 1 oll Expiration Date OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. ~ \~D .0\ JA\?A:lD Owners Signature: Inspection Request: 726-3769 /.. '?... .,,-~:- '" .'}- )t:l~iih~rirysenicesor Feeders '/' /I)/! :/?1 /' .", ~-i/,,;-- Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 ~'Ve~~09 ~IIlPs.or 1000 Volts see "B" above. D.' 'Brall.chCircuits $ 43.00 $ 3.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges .>:::':" "-'/'--' ..;.:....:.:....-,.:..,_.,:.-.<':' 4. SUBTOTAL OFABOVE 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)/Building FormslElectrical Permit Application I-Q3.doc MU~-~~-~~~~ ~~.~(. t-'.I::ll/I::ll " +- - - - - - - - - Entity/Address/License LICENSE NUMBER: 20-474C ENTITY NAME: THE MURPHY HARRIS COMPANY ADDRESS ONE: PO BOX 7632 ADDRESS TWO: CITY: TELEPHONE: SECTION CODE: . LICENSE TYPE: ~ LICENSE STATUS: :VALIDATION DATE: ENDORSEMENTS: :, EMPLOYERS: : RECIPROCAL LIC: CCB NO: 142410 :' AB EXAM DATE: EXAM DATE: : COMMENTS: INACTIVE FROM 7/14/03 TO 8/29/03 ~ S$=40948 ; CC HOURS TAKEN: 0 : CR HOURS TAKEN: 0 : NSF CHECK RISK: Screen - - - - - - - - + EUGENE (541) 736~7292 PRINT EL ENTITY TYPE: DBA C - ELECTRICAL CONTRACTOR ACTIVE ISSUE DATE: 09/16/02 09/16/02 VALIDATION NO: 0137354 COUNTY: LANE STATE: OR ZIPCOPE: 97401- DATE: 09/23/02 PRINT FLAG (Y/Nl: N FIRST LICENSED: 11/08/01 I ' . EXPIRATION DATE: 10/01/03 AMOUNT PAID: $125.00 CERTIFICATION LEVEL: START: END: SUPERVSR SIGN DATE: EXAM SCORE: DUE TO LACK OF 5S: CC HOURS REQUIRED: CR HOURS REQUIRED: MULTI EMPLOYER? o o SENT TO PHOTO 10: LAST RENEWAL SENT: 08/09/03 LAST UPDATE: 08/29/03 - OAVI +- - - - - - - - - - - - - - - - - - - - - - + :WindoWlEnter :Sv : SOftKeys': : Collector ~------+------+-----------------------------------------~-~-----~---~----------~ : Eo Off: FILTER: : Daviscl :August 29, 2003 : Level 1: . E copy OF ~~~~~g ~~ES DIVISION UCENSE ~ORD~ '_ BY 0,:" '~, o.,\/'), ," ~ OATE . ' t3.i2= ~"~ "~ TOTAL P.01 CCB#142410 @' . . \." .. .-......, .~-"'h; t', /'<ru1["''C\ T11e Murphy Harris COlnpany PHONE (541) 736-1292 FAX (541) 736-1273 P.O. Box 7632 Eugene, OR. 97401 Building Codes Division 'ss~e Date: 0911912001' Expire Date: 10101/2004 License No: 'ii094S ._t~" ~:, r Generalsu~~~or ..; '" " '-:~w. ...'; .'. .',. GEISLER STEVEN R 37026 Hl~LS,CR RD SPRINGFIELD, OR 97478 ~ ~~ 1?1. ".~ ~~'> Q~ ~ : SCOfiELD ELECTRIC co Fax:5416868696 ** Transmit Conf.Report ** P. 1 Jul 14 2003 12:46 fax/Phone Number Mode Start Time Page Result Note 15033782322 14,12:46 0'29" NORMAL o K JUL-14-20e3 09:~a Signing Supervisor Registration p.l2l2 Deplnmen[ of Consumc:r &. 8usiness Se~iccs BuUdb.i C~8 Dl.isien. IS3S Edge\6lalcl NW. Salem, OR Mailiflg a.ddress; p,O, 90% 14470.SlIlcm. OR 9'l(W -.. - ,Su.!) J'J'I~{;SOJtllS-2JZ.'Zi'TTv-:-(~)r;-1~llS' '0", '. -.--. \1<"'. .otegoltbed. org .,----- -- - - - . 't;;i~~{~~I~'~~:~~~'~~F~~~~'~~~~~ l~t~; ~t~~;lf~ {~~t~~;t&~l~!'~ ~,t~~! iJ!f~'::,~.;~:~J~)1 ;., ~:::'~1 ,~:~:ry~Ji,~t'i.it~;~. < .{1\.~ _ it,'1 ~~.,:~~:t~ ~ ~',~:.'~Y(~<::\~~' :~~~~~::~~i;,":~~,~>;~~ >~I~J$~;l~rt:Af;~ ~;t~~i?~~~~1<; (, lhe undersignc.cl.JU or . ~in KfYe il6 (na",e:) (due~ (Please check orte): a licel\sed gcnenl supervisor cloc(ncian , o Limiled joumtyman .sign electrician o Limited enerCy electrician fOf (comp,l\Y name) Company address: Cit>,/SI2,telZIP: Compa"y license no.: Phone:(. ) I ....il/ sIgn alllablel epplic.l{ions and countersign alllablels. As supervisor. I will be responsible for ehS'Ilring that all e.lcclnul iflSlallations meer minimum safet)' StAlldlltd$ and thai all s~h installations ""ill be rnBdc in compliance lI>llh, ORS 479510..8'0, . > Signature: , QuaJify;ne signer's hcr:nse no.: :foc... ~~:-'L- {112ft":) . will not be signing lhe undcrsigntd. as of ) - / ~ . o::.s.. (dace) for ~ JtY1 v-~ --/' J.h,,:..:;. (CO"",,,)! "1'-) CompanyaddJess: Eo (.:bx ?, '3 Z. City/SraaelZJP: >. h -F~ , (C)~" 7 7 Sto ( ;, " ((t') , 4A~ -r- Pbone: ( ~ 1 ) 731a-/29'Z- Qualifying signer's license no.: Y6{., 'l <;, J~~-14-2003 09:40 P.02 .,.,... , . . . . . . . , . "'. .,' Signing Supervisor Registration - DepJrrment of COnsumer &. Business Sef'rices Building Cedes Division' 1535 EdgC\bBter NW, Sak:m, OR Mailins addre~s: P.O. 8o.x 14470, Salem. OR 97309 (S03) 373-1268. Fax: (503) 378-2322, TTY: (~03) 373-1358 "'ww .o~tonbcd.org ;'[~: i~~~~~?t1~~{~~{~:}~;~ ):}~~L~~~~Ji~ '~~~:"7' 5.~~~~;?~~~:,~:f~ ~')~;t~f~l~~~ 1 !~~1~ ~~'~r: ~:~~~lr~~~~l. ~ r ~~1\t~?I~L_.X~l:! :", '~~~t~,;~ r IcJfl~~~!i~~.;;~~~;1~~7~~~~%}S~)!;;~~:~;1 ~~~~~1~~{~~:;' t, , the undersigned. as of , . will &em ec (tt.2lne) (dale) (please ~heck one): o Licensed general supervisor electrician o Limited journeyman sign electrician Q Limited energy electrician 'fat'. '.' -..., --"-- - -, ',-- -'.. (company name) Company address: Cit)fStatelZIP: _ Company license f1!J.: ,Phone: ( ) I will sign all label applicillions and cDuntersign all labels. As supervisor, I will be respOnsible for ensuring (hil all electrical installations meet minimum sarei)' stBlldllTd.s and that all sUch inslallarions.\to'i11 be made ,in compliance v..ilh ORS 479.510-.850, Signature: Qualifying signer's license n,O.:_ ~l. -., ~ " ' Jc~'J C~ Joe- k-Se.-k: -L- (~c) , the undersigned, as of ) ~J 1I . t).:::!> (<<Salc) . will 1101 be signing for ~ X'1,;.J:I ~.~. (rf). ~ , (company nilme) Comp~ny address: Eo Clo x /b '3 '<'- Cily/$13telZIP: ~f"~ ". ~ R. ! 77 ~o ( ;- " e.( ~ compa.nY.~',_~._ Signature' , ~/lt." _ Phone: ( S'J ] 7.fk -I '2'7L - ~ ) Qu~lifying s;gner's license 00.:36b 'LS Q Employer nOlified Date: By (iMi.aIS) , _.... Comment:_ ~. ~~$SiM~.' 'IlMVRV~' "o.2~~~ (7102/COM\ TOTAL P.~;>