HomeMy WebLinkAboutPermit Electrical 2003-8-29
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726_36~9 (J Db ~,nt~
ELECTRICAL,fJllVlt.f!' AfP/4CATION ~ ~ rfr
City Job Number l';t) .lV\(f\~ Date fl. J
I. WCAp5!JN OF INSTALLA'?ff 3. COMPLETE FEE SCHEDULE BE V
\ Q t) \v\ \'\\Lr Cl_ >tJ
LEGAL DrL~I~ A ~ -:z...
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JOB DESCRIPTION
( ~~~
Permits are on-tran f: able and ~e if work is
not started within 180 ys of issuance or if work is
Suspended for 180 days.
A. New Residential- Single or Multi-Famil)' per dwelling unit.
Service Included
-tu~
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
2.
CONTRACTOR INSTALIATION ONLY
B. Services or Feeders - Installation, Alterations or Relocation:
Electrical Contractor The Murohv Harris Compan}WO Amps or less
201 Amps to 400 Amps
Address 149 9th street 401 Amps to 600 Amps
601 Amps to 1000 Amps
City Springfield Phone 736-1292 Over 1000 Amps/Volts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Supervisor License Number
LJcr( i{ 5
l D] i I 03
t
c. '~T~lf!~f~.n.:,Senices or Feeders
Constr. Contr. Number
20-474 C
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
$ 50.00
$ 69.00
$100.00
Expiration Date
Expiration Date
1X~)l , (D~
Over 600 Amps or I 000 Volts see "B" above.
Signature of Supervising Electrician D.'Bcinc~Sj~cdi~
$ 43.00
$ 3.00
Address "'" 1.2 $\.i1 (~I~"l\.Dn.tb E."~,fi~~ella~eo~ (~ervice~f,~~~i.~otinc1U, d~~)-EachIn.. stallat.i 'on
-LJ~ ..~. '-~ \l 0'" .. ",.c"
City \(.e~ Phone Pump or irrigation $50.00
Sign/Outline Lighting $ 50.00
Limited Energy/Residential $ 25.00
Limited Energy/Commercial $ 45.00
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature:
~;1\\D ~
~~~.1D'
SUBTOTAL OF ABOVE
7% State Surcharge
10% Administrative Fee
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)lBuilding FonnslElectrical Pennit Application 1-()3.doc
MUU-~j-~~~~ L~.~r
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+- - - - - - - Entity/Address/License
: LICENSE NUMBER: 20-474C
: ENTITY NAME; THE MURPHY HARRIS COMPANY
ADDRESS ONE: PO BOX 7632
ADDRESS TWO:
CITY:
TELEPHONE:
SECTION CODE:
I LICENSE TYPE:'
~ LICENSE STATUS:
:VALIDATION DATE:
ENDORSEMENTS: '
EMPLOYERS:
RECIPROCAL LIC: ceB NO: 142410
AB EXAt-I DATE: EXAM DATE:
: COMMENTS: INACTIVE FROM 7/14/03 TO 8/29/03
~ 5$=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 ZIPCODE: 97401-
DATE: 09/23/02 PRINt FLAG (Y/N): N
FIRST LICENSED: 11/0S/01
EXPIRATI9N DATE: 10/01/03
AMOUNT PAID: S125.00
CERTIFICATION LEVEL:
START: END:
SOPERVSR SIGN DATE:
EXAM SCORE:
DUE TO LACK OF 5S;
r I
,
CC HOURS REQUIRED:
CR HOURS REQUIRED:
MOLTI EMPLOYER?
o
o
SENT TO PHOTO ID:
LAST RENEWAL SENT: 08/09/03
LAST UPDATE: 08/29/03 - OAVI
,
,\
I
,
+- - -, - - -
:Window:Enter :Sv
- - - - - -
- - - - - - - - - - +
:SoftKeysl
: Collector
+----~-+------+-------------~--------------------------------------------------:
:Ecj Off: FILTER:
: Daviscl
:August 29, 2003
: Level 1:
e copy OF
~~~~~~~ ~~~es DIVISION
UCENSE ~ORD~ .
BY (\ - .€]i.6;I0~
DATE". '\.
TOTAL P.Ol
CCB#14241O
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-.' -. ,-, ".=-.
=-~.. h:i.-
The Murphy Harris COlnpany
PHONE (541) 736-1292
FAX (541) 736-1273
P.O. Box 7632 Eugene, OR. 97401
Building Codes Division
Issue Date: 09/1.9/.200.1'
Expire Date:1u'/01/2Q04
License N~;"~~94S
General $ul?~~Qr
GEISLE.R STEVEN R
37026 Hl~lSCR RD
SPRINGFIELD, OR 97478
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SCOFIELD ELECTRIC CO Fax:541G8S8696
** Transmit Conf.Repor~ **
P. 1
Jul 14 2003 12:46
Fax/Phone Number
Mode
Start
Time Page Result
Note
115033782322
NORMAL
14,12: 46 0' 29'"
o K
JUL-14-2Ge3 09~Ae
Signing Supervisor Registration
p.B2
Deplnmtnt of Consumer &. 8usiness Se~iccs
JhaUdl"t Cedes Dlvisieta . 1535 Ed&e~atd NW. Salem, Oil.
M.eiiillC address: p,O. 90.1 14470.,5.lcIII, OR. 9:'1)CW
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dle u"dersjgne4.~\of
. . ",ill acNe 'Iii i
("Brole)
(due)
(Please check of'e):
a licef\sc:d genenl supervisOr eloctrician
o Limited joumc:yman .5ign eJe:clrician
a Limited eM-fCY electrician
(Of
(COlTlpOllftY name)
Company address:
Cit)'/S(a,Ie/Z.fP:
COrflpany license no.:
Phont:(
)
I ~tl/ sIgn all label epp'ic,l(ions and countersign all labels. As supervisor. l will be responsible (or ensuring thaY all
e.lectrical inslallations mec:r minimum safet)' St6l'\dards and thaI all 50th installations -ill be rn&de: in compliance "'llh
ORS 479.510-.8'0. .
SignalUrt: .
QuaJifyinrsigner's h,cens.e no,:
-
~ I. Toe.-" '-s.:.1c...~ -'L- ...' . lhe undersigned. IU of "} - / 'I. 0'::> . will nDl be lignin!
" ~ (1I)",e) (dau:)
~~'> for ~VV/~.J:I Jh".:~ (c9.
~ (CVrnpllll)l hl_)
o Company address: P. 0 ~ X /b 3 Z.
Cify/SlalelZrp:. ~~ ,; (C) ~ ., '17 sto (
Pbone: ( Stt 1
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Qualifying signer's IKense no.: tJb&.~ s.
~
, .
J~_-14-2003 09:40
P.82
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4. ,"
'Signing Supervisor Registration
DepJrrment of Conwmer &. Business SCr'ficcs
Building Codes Division. 1S35 Edge\loarer NW, Sale;m. OR
Mailing address: P.O. Bo~ 14470, Salem. OR. 91309
(503) 373~1268. Fax: (503) 378-2322, TTY: (503) 373-1358
VllII/W .ore.gonbcd. org
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the undersigned. as of
, will sem:_,
("ame)
(dale)
(Please ~heck one):
o Licensed general supetvisor elccrrician
o Limiled jOurneyman sign electrician
Q Limired energy electrician
'for'" _.~~ --'-- --
(company name)
'Companyaddress:
Cit)'/SlatuZIP: _
Company license no.:
_ __ Phone: (
)
I will sign all label applicalions and countersign all labels. As sllpervisor.1 will be responsible for ensuring rtlll.l all
eleclrical inSlallations meel mil1imum safery standards and lhat all such install.,ions will be made in compliance v.ojlh
ORS479.510-.850. .
Signature:
Qualifying signer's license no.:. .
~}::~;.t~;.>;C>~~~'i :\:~~::,;~i~i'~"~;f,g;i J~~\ii~~'~1\!.:~~{:fl{', :;~J~:;/,}{.~~!~~~,E'~~~:~l~~~J.t :'. A1.S'., \. ~~'J~.~: ;;;f;~~1~W:~~2t~)Tl~ I;tif~;t:;~~~J~~J~ ;,j\{{~i.%~.
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( notIlc)
rhe undersigned, as of ) ~ Ill- b.:::s.
(CS'II:)
. will not be signing
for T"k- 111~.,{ V tk,~.~
I ";.
Company address; P. (') ~x
Cily/$18telZIP: G:.r~;, ~ '<. .
companY/ieens nO.:
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~ ~ ,/ Signature' '., ';...P .-
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CC).
(t.'Qmpany name)
?b :3 <'-
77C;o {
____ Phone: ( S'I J
7 .:?k - / '2 '7 L
Qu~lifying signer's license no.;Y6t:, 'L,S
Q Employer- nOfified Dale:
By
Commen<<:
(initialS)
1~~'
A4G-H~.e (7102JCOMI
TOTAL P. a?