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@....@ ~
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/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
"
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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