HomeMy WebLinkAboutPermit Electrical 2003-6-13 (2)
:t, , (..... ;. "... ",'~ '.'~.. , ," I" ';.".'
.. ,'"',-,,,:,,:- ':.CITYOFSLdNGFIEED OREGON '.".." /':'...
fJ' . . ;'. . t.". _ ,.-' ~ .,. ~., ,',,""" ,
225 FJFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F" Y1' {,'4H.'I.?&.ltill91s submitted has the following
Hte on<JW1''In''''1 '''lc land use
ELECTRICAL PERMIT APPliCATION zoning, and does nol requlfe ~~~9' I
City Job Number t3-ezoc3-OD/I-f:> Date ~//3,101 approvalzOnin" c:.-. (l ,
( . '7 ~ - I _ /7~t>?
3. r:;;'c'fiMPIilltEfJimSC;'nuiJiill'1$J:.Lo.l1t" ,t' '<:1;/,;,;,"7,\ ;,~; 1
it.'." ,,' .'L ,,'-" . "'"'>t~~J~~~~~ri~'-~d -S~;~~~tui~! .,'l.....,,:":,~.I"!',l.'..;'.r.;~',J'~~"'u ':..,1
200 Amps or less / $ 63.00 tJ? J ,DO
20 I Amps to 400 Amps ' $ 75.00
401 Amps to 600 Amps $125,00
_~~Amps to 1000 Amps $163.00
Phone S41-688-6121 ~ ~\()~ 1000 AmpsNolls , $375.00
~ '\'<' :\ \sR~eonneet Ouly $ 50.00
Supervisor Lieeuse Number -.J.7 SgS . ~ .~~~:~~~~~\iiUpjif;tiY;&e"ri\.J.se*~€~~ii:s.:!)i;.:;;iI!,:::i,~~Y-:;;:.~ ~~';;i:,,:,;" ~:&,~
~:. '0'<''(' ~~' 'X-~\j
Expiration Date . 1966WQ4~~\- \\~~ ,c.,_~'?) Inslallation, A1leration or Relocation
"~\'O '< ~~1..~~\) \)~~~\)\>' 200 Amps or less
Constr, Contr. Number '\ '(Jl;'i.'9:4():-~" .~-4. ~, 201 Amps t0400 Amps
,(,(~~'\'O~ \>' 401 Amps to 600 Amps
Expiration Date 1010r'Loo.
t.
Signature of Supervising Electrici
. ' 4 IU /J NOueWcAlte~ation or Ex~~~~o" Per Panel
< , T.<ln-v ( ')/ e IfCUlt . \\,eS' \\,\i\'l $ 43,00
( Each Addition~I'Circuit br with\< / I
/' Setvic~ br'l\eede'i'P6'nnitSe\ 'QO\ f. $ 3,00
OwnelSName ("};t.a S-rR-AS(!,A-v,tfJ-l \0\~'U'~'~"O'O'J'. ",\eS':"noF::J~' l"
~.. ,..\ 6(fl.Gr...".tfI...'r'.,.!;....~...d~'....:\!"..,.:~"..~~~~r::!.I..\..~.:i';~........""'..~\.,y.;;.....'1.,,"I.J....~. :~~;.'~
Address 3l~ l4. ~ q, ~ ,\ \ \.- r\ \\eS E:(~~~~~J!~9~~~~\~!{W~$![~~H~lj!~}!~:~C;1~~~qt~~~~~j~n~t~l~~.~!~~~
e R. C{ll(6 \01'-'" \,O~ Cu,~.CO"\~ ,. r.,o'9'(;-;' - \e\e\>:'- \,o~
City f. ~Af.. Phone .~;.\IC'" n,,~.\)\Pum~9niiTigati9ri~e ~IO\'\\C'Oo $ 50.00 .' - J
) \' ",",,,;; "1" IN')' ,.,."I\~ - -
'n 0'" -/0" \\'Sigu/0utline Lightillg' n' A.'. $ 50,00
.\" "v..... r-~\'" 00\\ ~ ('\_'~.JW"'I
OWNER INST ALLA nON , 0090. \' (Ie;) \r-r.iffiited\Energy/R2sidential $ 25.00
ca\\\ \I~I.\1 ~~ , . ~ .'6v -. ,
The installation is being made on property I own which ",\)el Lumted Energy/Commerc131 $ 45.00
. . ~.. ~-
IS not lOtended for sale, lease or reUl. Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
c.l
7)
~zS
.'],S{;)
B 7, 75'
,
I. ttt. 'iotAtj6N/dji/iNstM3:t:AnON6;"";~~:~1;;;..I
E' ,',.,.".. <.", ..."'-_",....,'-4",."", ". '., ,r_,'"'''' "~'A".,.:..""l_.,J".r~
-f.3.!/I> 1)",0 1 <;:: 1M tr
LEGAL DESCRIPTION
/703"2.700
Zst>
0690..3
JOB DESCRIPTION' I StAt, 1/t7JGL ~
4 C r/2..ui. JJfJ r;~ {/f/lt.:( Pa-JI./Tl /J(,
Permits are non-transferable and expir; if work is fi1}/At I,
not started within 180 days of issuance or if work is
Suspended for 180 days.
lifCONTRAeTORiiNsla,.;r5iTiON70m]Y;,,-,j'
2. t8'~,...;J~ ,,;:~-,-~..,..r..' ,~;"'l'~';~_;,h,' ?1"~'y,"\(r"","'~"J'<""",'".~@;"",i(.1 ,"~1;t.'i'~Ir:".:_A"!t"""1i:S
/
Electrical Contractor .rh;-i ~t-= 1<'1 ",..t-,.i,..
Address
1 ?qR R"t-h" 1 f),.i""
City
Fllg~nc
OwnelS Signature:
y .
Inspection Request: 726-3769
~~\f1
A. RNj~'i~!~i~a~e~!flffi\$in'gi_~~~,:~~Wli!~fh:.n.ilt.\~er~~'~~ilii~g~.~wt L11
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$106.00
$ 19,00
$50.00
1~r'-"1"""~~fz.#" !..Jt"';'rq~..~.'"-' ';.r- .';~kl-'''li;'~'-. ,r, "~J"'I.'T;- j,"'-~'''.:a.~''t.....,.-.... :'j'-., '-":~'l'11
B. ~{,~~i~f~f~~:~:!~!I~~.r~J..t~~!"!~~\i,?~i;_~;I:~~htt~~~~~t\]!.~.I.o~~tJ!~~ih;i,SJ
$ 50.00
$ 69,00
$100.00
.}
/Z
~
ltt..,~ ..tf<II:.~"""';"..)rt~~r.~1:'_"" H:':~JV.:.';u~_:,':'I'T_ 'it&;....;';".~~~..-~~;j~'..it~~'
4. f!SUB1iO!FAEOEiA'BOVEf...."'iVit.",~t,i,,;''''~t!.lii
~i..i'i~~",.fi',,~~.:,.:....A.~I'MiJ...I',l:>~~.'j~;!..;t~~1.ijf."'?j;AUI-t.~1t'l:~. 'ft<
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)IBuilding Forms/Electrical Permit Application 1-03.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:
ELE2003-00145
6/16/2003
6/16/2003
12/16/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
1940 DON ST STE 250
1703270000903
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
PROJECT DESCRIPTION:
Add sub panel and 4 circuits
OWNER! APPLICANT:
STRAUSBAUGH GREGORY L & ~
3642 RIVER POINTE DR
EUGENE OR 97408
ELECTRICAL CONTRACTOR:
CHRISTENSON ELECTRIC INC 541-688-6121
1631 NW THURMAN 2ND FLR 543-419-3600
PORTLAND OR 97209
CCB # 458 Expiration Date: 05/01/2007
DescriDtion Amount Paid Date Paid Receiot Number
+ 10% Administrative Fee 7.50 06/16/2003 1200200000000001534
+ 7% State Surcharge 5,25 06/16/2003 1200200000000001534
Add. Alter. Extend Circ Ea Add 12,00 06/16/2003 1200200000000001534
Perm ServlFdr 200 amps or less 63,00 0611612003 1200200000000001534
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 Electric Service: Approval required prior to utility company energizing service,
3 Final Electric: When all electrical work is complete.
,0
By Signature, I state and agree, that I have carefully examined the completed application anddo bcr~by,certify that all
informatiou bereou is true and correct, and I ~rther certify that any and all work performed\rhail,b~'do;lldn accordance with
tbe Ordinances of tbe City of Springfield a~~~ laws of the State of Oregon pert",i,n,i.ng i~'ilie.~~(t'de\~~l!ed hcrein. J further
certify that only coutractors and emplof}~ ".@i are in compliance with ORS ?.9!\055~iII'be used onJlils project. I further agree
to ensure that all required inspectio!'8,,~ J!i9i&sted at the proper time, thiii'~acb,a'd'dress i~~~-;;adabie:fro~the street, and that
the approved sct of plans, if apPIi~lsIm~'1I~ll8in on the site at{'n.tiMe;,du'l-ij,'1i\c'6lm~-uctil.'rl:. -0\ \'(\'" ~'(\o<'\":'o(\
;$-~c.. Q,~:~~ f>-~\~ ~~~e; ce~~~()()\~ ~'~o~\~~'(\e \~~~\\~\G'3-\~
. . , ~I", ~~.J ..."';V \0. \c7>\y. ~'-:- (\'v v,,:"''O.\ .".,,\0. .;~'~ ,.... ~..,
Owner or Contractors SlgQ~tUf~" &~ ~o\\\ \I-?> g"D~.t~>'l (\\e~'" 0<'\ \)\.\ 2:??""
~~ ~<<; ~ ,(\0 'lol,) eGe o~eg 0'?>~
'N<i,'';:- -\::'~R-f?~~. \()g()'~\w9>\'f;\ ~\'(\e. \'~C'l
~" fff ~~ ~ ~ fff G'O: :ue~ \0 ~\e~ \5
~~ ~ ~ ~<i2' ~<<):A Q, ~'V~ ce
",-<:- ~-<:-.~ ~~
~ ~- 'b~
,,~ :A"
~
Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 145
ELE2003-00 145
ELE2003-00145
ELE2003-00 145
Payments:
. Type of Payment
CreditCard
.
/
6/16/2003
. City of Springfield
Development Services Department
Puhlic Works Department
Official Receipt
Receipt #: 1200200000000001534
Description
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% Stale Surcharge
Paid By
CHRISTENSON ELECTRIC
10:48:16AM
Received By
djb
Date: 06/16/2003
Amount Paid
Item Total:
63.00
12.00
7.50
5.25
$87.75
Check Number Confirm No
000095 086363
How Received
In Person
Payment Total:
Amount Paid
87.75
$87.75
Page I of I
cReceipt.rpl