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HomeMy WebLinkAboutPermit Electrical 2003-4-9 04/03/03 THlT 14:51 FAX 5417263689 CITY OF SPRINGFIELD 141 001 , s submitted has the following 'i25 l'l.l'Hl STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . F<<i~4Jff1g~36~t require specific land use ELECTRICAL.PERMIT APPLlCATI;ON t:. Zoning r~~ Ci1}' Job Number e:k-Z60J - DO/OLDate l!, 9; 6') I)'\te 4!-=f1@....@ ~ .' .. . ..' ).:,:;...:.... .., '.~~~ij.;j;::S:..3i~~,~,,;{. ::":.':-y.. "~-::S"";.h. ).., 1..i.i:!.~:C:lP~'9l[:!.Nsi40TI.9.~'... 3..g :/~f411:. .it:(~~ ~~~'-~~~:l!.Ehf)-l4 , .. .:::':~B'tV~><! /l)90 e~~/ ~ tEGAL DESCRIPTION 170-] Z2LO JOB DESCRiPTION "ti!~A:rn-{l/I&.n/6 61f $bf'~~ ~ Permits are non-transferable and e;t;pire if work is not staeted within 180 days of issuance or if work, is Suspended for 180 days. . 02300 , 2. I:'Sq~~9:#9~:'l;if~#1~t~n~~;ip~1f~;;!1. Electrical Contractor .:S~~ G.e-~-i1et L Address I ~ C t#- "5 ~ Delt ~ c..o City M I LW{h)~, ~ Ph()ne 50 $-/f"z.~ Supervisor License Number 3/965 Expiration Date _ / p~ ~ .'? "; Conso'. Contr. Number. 4-$2-:3> Expiration Date 5/Zt/"I; 4 Signature of Supervising Electriqian " './ J1l~ ~ ,_,_" . ~ Ownc~Name ~/L~d ~p/e W . I ~ Avt-~" fy Address 372 City ~ ~&~ t5" Phone OWNER lNS'fALLA TION The installation is being made 0111 property I own which is not intended for sale, lease or rent Owne~ Signature: - "':- Inspection Request: 726-3769 ~ .i :.~. A. :::N..~F:;~~i~~~.ti~~:~~;.~~~.~~;~f M~~~~~~~~~t~::~~f::.~~l~i~~i~,:;';::. Service included 1000 sq. ft orless 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. :.':~AB,~F,~,;~.f:r'~F#i€~'.6~~~~i'~g~~~,,~J~~~~i?~.':,~fr~~~~~;;tii~~~-' ... 200 Amps or less $ 63.00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 60 I Amps to 1000 Amps ~S $163.00 Over 1000 AnlPsNolts \}\t9S':lOU'~~}J $375,00 Reconnect 08",a'l!ll ta~o egof\ u\\ ,:'r\ $ 50.00 ~.Otag \\\9 t S9\' .. " ~\1~~~_~~~~~~_~~:~~, ' ; ..: ':. ... "'::.::;<:.!:?;"". \O\\O~. car.\9 ."O\\\tOU~ . a\ \~9 tU e . o\\\\ca\m]'~~~9Aft<<6uP~,~~'i~P'on ~"o~~ ~~~ g'pl:-~ \~O\9" ~~ ~o\\f\C&.\t $ 50.00 OOgo.'1g~~~\tb~P\~ 2'344" $ 69.00 C&.'~ ~~Rl~~s'3'3Z- $lOO.OO u~b 'let \S . " Over~Amps or 1000 Volts see "B" above. D. !E~r~~~~,.l9.if~~i:~~":'.'::::1:'n!:-,:.;:(<(n'i:!,.+Ii,.;;.:,:..:Y"T{;;<H:;~-I: ....;.::.::,::;~~:t':,,',:' New Alteration or Extension Per Panel One Circuit Each Additional Circuit 01' with Service 0, Feecit.< Permit $ 43.00 $ 3.00 E. .tJ~~:f!!~!f'{~~~fff~~T~~i;'t~~~;iM~~~:~~d:. "t)~q~~'or ~ggti.~~\.. t.~~\S ~t.\\W\\\ '? ~ $ 50.00 \\\~~. ~ bill~ 1 ","OOl-ltO ~\J" $ 50.00 . ~1J1i~Q~,fr-\.~b:t~~al $ 25.00 . C&~~~~~~~~~tCial. I ,~~$.OO #- il cJ MinjfWI~l Jfi~ctric Permit Inspection Fee is $45.00 + Surcharges . . ~'. .. 4. :,ii~W~~~f!',~~:I~Nf':.:i,'i,!;;'i?!:';:?!';'.!i:j.;..::;.;.:.;;:;ii,:;':':,:i.'; ~c) 0 . . 3,/5" '1-9 '3~f bS" 7% Stale Surcharge 10% Administrative Fee TOTAL Shared Orive(T;)lBuilding FonnslElectrical PcmUl Application I-OJ.doc City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: . EXPIRES: ELE2003-00102 4/9/2003 4/9/2003 10/9/2003 SITE ADDRESS: 1090 'r;~~~way Lp ASSESSOR'S PARCEL NO.: 170322200BOO Springfield TYPE OF WORK: Addition TYPE OF USE: Commercial PROJECT DESCRIPTION: Low voltagc OWNER/APPLICANT: ELECTRICAL CONTRACTOR: STONER ELECTRIC INC 1904 SE OCHOCO MILWAUKIE OR 97222 CCil # 44823 0 Expiration Date: 03/2012004 ~. ~,,) .~'" \ ~ Date Paltl:=> ~~ ,o~ ~ Receint Number ~ - O~ e' ~ + 10% Administrative Fee 4.50 04~l(0~ ~0q; f:J~ ro'(j) 1200200000000000987 + 7% State Surcharge 3 15 \~L-R~~1b' ~q ...,s..(/) e 1200200000000000987 Low Voltage - Commercial Indus 45 00 ~o~ ~fJ}~}O~ ~0 ~O~.o~1200200000000000987 ~~(~0 ~~ ~lll is j 'l1'.eP.'A\'V~~ To Request an inspection call the 24 hour l'Clordlllg at 7~.Q)'H)9~c:R1lt~ ~~~~I$~J.~)ore 7:00 a.m. wiIl be made the same working day, inspections requested after 7:00 :1.111. \Vi~~ ~t ~~Wn~~~~~' ~ ..\..,.;:) ('\0",,-'\' _ ~~ \~O ~~ n;z,f?> ----- -~ ~\,)- ~e!1f' ~ 3' ~0\' J: ;60' ReQuired Insoections: \0 ~,C~Q)~ ~~'lf. cJb~ O"'~<o~~ 1 Low Voltage: Prior to cover. ~:O~(;)~~~~:...~0 ~>co '\' ~ ~~ ~~- ~~ ~,f(; By Signature, I state and agree, that I havc '~;m:fully e~am~~ oo~pleted application and do hereby certify that all information hereon is true and correct, and ~ further ecrtif5l''tbat any and all work performed shall be done in accordance with the Ordinances of the City of Springfield al,ft tile laws of the State of Oregon pertaining to the work described herein. I further certify that only contractors and emplovees wh') arc in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections arc r ','uested at the proper time, that each address is readable from the street, and that the approved set of plans, if applicable, will remain 011 the site at all times during construction. : 'NO~'& S; \f \\\~ (' ",0\ .Date ~~~~\'i.; X\\J\\ \ ~.... ~()"\C~. ~\\ ~\\~~i~ \\\\~ ~~\'\~\) rO\\ \\\\~ ~~~\1t.\) ~6~ \<2> ~'O~\'\\) . ~~\ ~t.~Ct.\) ~t.~\0\)' . . COWl CO\) \)~i ~~'{ '\ FRED HAMPLE 372 W 12TH AVE #4 EUGENE OR 97401 54] -683-0653 503-462-6500 Descrintion A 111011:11 Paid Owner or ContraCtors Signature Page 1 of 1 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone L~L':"'\J,--)_"I-V\Jj ~-,2 ELE20\J.)-liU 1 02 ELE2003-00 1 02 Payments: Type of Payment Check Paid By Receipt #: 1200200000000000987 Date: 04/09/2003 + 10% Administrative fee :_.",' \'u::,,~c - COIlll1i~'I~'i~d ];'L:US + 7% State Surcharge STONER ELECTRIC Received By Check Number Confirm No djb Page 1 of 1 4/9/2003 3:18:06PM . City of Springfield Development Services Department Public Works Department Official Receipt ;,".00 4.50 3.15 Line Item Total: $52.65 How Received Amount Paid In Person 52.65 $52.65 parment Total: .. .- cReceipl.rpt