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Home My WebLink AboutPermit Electrical 2003-2-19 I e !'III"",..,,, 225 FIFTH STREET. SPRINGFlELD, OR 97477 . PH:(541)726-3753 · FAX: (541)i(?,~",3689 "'."l,,~!.,,~ ""tlMiHQr/ h ELECTRICAL PERMIT APPLICATION 6~if>ld~8:""" ~'~'''~' "--,~..c _._~_,~~~~7,~o~~:;ng City Job Number EN? )fJ7Jo - 0004r Date ;;;;J-- 19"-03 lOrtl'I[l_~ 3. i;fQJllj;~E;?rE, FE1;$c~;flI:~;)JiiiJt~~Yj::_~~'~. ,,~ ...", .M'. , '" ".,"1' ,,-.ecrs~nature'~A' - -~= ..,\ Expiration Date 10 - L:>c.. . _ Over 600 Amps or 1000 Volts see "B" above. Signature ofSupervising.Elec~n4'CE: H^ll EVP\R.D{ "~~~~(;I~.'7" . ~ M\i S /"\ ^ t I,," ...,.. .. , . /f7 /;! ~ I . HilS PER ZED UNDER THIS PERM\~l~~g.1 or Extension Per Panel {fhd/~ ~-AUTHO~I OR \~ ABANDO~JJ~t _ . CUM\V\tI~ere-pERIOD Each Additional Circuit or with ' . ",NY i 80 DAY' Service or Feeder Pelmit PI An b\! IIUi\! Vl(:;iiIU' '-'n - ... $ 000 lOne t-" - , '. ~ f, iui,ump)QfIl:F:!g}.98l\v 5 . "I U~'~VV I.UIt;!~ aaopted byt$l~lttdioelIti1gl1ting $ 50.00 . ".otJf/catlon Cente . . oJ' ~ "'y OWNER INSTALLATION in OAR 952-001 I. ThOsELHn'ft'eCOc1Bife~tR~~idential $ 25.00 . ... n . -OOlOthrolH'lh.r)8.pQ,l::;~,N\I'\_' / . The mstallatlon IS bemg made on pr6'p~Gy '(foWH1whlO.9bt . !;Imlte'd'cnelg)'/(!:ommerclal $ 45.00 .. " . '-'J am copIes of the rules b IS not mtended for s~le, lease or rent. callmg the center Minill1umJ<'Jectri -Permit Inspection Fee is $45.00 + Surcharaes . . \1 ~ULI:;:. U Ie-tele b . numberforthe OregantSl+" Owners Signature: r;r,,.,tq' ie:: 1"Rn~'-i8~~~84 " 1. I 8 J~ 0. <'::>\ <; \) v'--rLc. f:.t'y \J . I LEGAL DESCRlPTI0N JOB DESCRIPTION J~ T , f'rJw ~~~;\r - \~ l\rt.\\Q<; c" . ~0( J V~j <;. t ~ L- - Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. Electrical Coritractor /'") CtJ b.ftl Qp~U y ;-KL- - {/ I2dl Address 46 .r VVI go, I Phone /;f b /-Li h 5 1- -... . City €'Uj~ Supervisor License Number 1)-6...::.1- L f/A Expiration Date /6 - 0 1- C> S Constr. Contr. Number b 170S Owners Name Address City Inspection Request: 726-3769 A. 'N~jJ::~~~idli~(i~ 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. 200 Amps or Jess 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/V o Its Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 c. Installation, Alteration or Relocation 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps $ 50.00 $ 69.00 $100.00 $ 43.00 $ 3.00 E. 4~- 7% State Surcharge 10% Administrative Fee ,~.l' -I. ,SO S;J,. ~ TOTAL Shared Drive(T:)/Building FonnsfElectrical Pennil Application I-G3.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: ELE2003-00048 2/19/2003 2/19/2003 8/19/2003 SITE ADDRESS: 1812 Q ST ASSESSOR'S PARCEL NO.: 1703252405400 Springfield TYPE OF WORK: New TYPE OF USE: Commercial PROJECT DESCRIPTION: Limited Energy wireless Alarm System OWNER! APPLICANT: ELECTRICAL CONTRACTOR: ANIMAL PHYSICIAN & SURG PC 1814 Q STREET SPRINGFIELD OR 97477 CCB# Expiration Date: Descriotion Amount Paid Date Paid Receiot Number + 10% Administrative Fee + 7% State Surcharge Low Voltage - Commercial Indus 4.50 3.15 45.00 02/19/2003 02/19/2003 02/19/2003 1200200000000000722 1200200000000000722 1200200000000000722 To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 am. will be made the same working day, inspections requested after 7:00 a.ill. will be made the following working day. ReQuired Insoections: 1 Low Voltage: Prior to cover. By Signature, I state and agree, that I have carefuHy examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, and that the approved set of plans, if applicable, will remain on the site at all times during construction. Owner or Contractors Signature Date _ -.: iO'\j'Oregon laW requlre~ you l.1J ,..:..1 I t:N I I.. Oregon Utility fOIIow rUles .adopted by ~h~Ules are set fort Notification Center. Thos hOAR 952-00"\ ''', OAR 952-001-001 0 throug b' Ii, - btain copies of the rules j 0090. :ou r:a~e~ter. (Note: the tele~ho~e callmg th UtTty NotificatIon number for the Oregon I I Center is 1-800-332-2344). NOTICE: ~g:k;1~ ~%~~~ ~~~~~E'~~~E,~~~~ ANY 180 DAY PER:~~.BANOONED FOR 1 of 1 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone .Ie Items: Job/Journal Number ELE2003-00048 ELE2003-00048 ELE2003-00048 Payments: Type of Payment . Check Cash Line Items: Job/Journal Number ELE2003-00048 ELE2003-00048 ELE2003-00048 Paid By Description Reccipt#: 1200200000000000722 Date: 02/19/2003 Low Voltage - Commercial Indus + 10% Administrative Fee + 7% State Surcharge JT AUTO REPAIR RON Description Received By Check Number Confirm No 1kw 1kw 99 Low Voltage - Commercial Indus + 10% Administrative Fee + 7% State Surcharge Page 1 of2 2/19/2003 11:38:37AM City of Springfield Development Services Depaa Lment Public Works Department Official Receipt Amount Paid 45.00 4.50 3.15 Line Item Total: $52.65 How Received Amount Paid In Person 51.75 0.90 $52.65 In Person Payment Total: Amount Paid 45.00 4.50 3.15 Line Item Total: $52.65 cReceipl.rpt 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone .ments: Type of Payment Check Cash Receipt #: 1200200000000000722 Date: 02/19/2003 Paid By Received By Check Number Confirm No JT AUTO REPAIR RON 1kw 1kw 99 Page 2 of2 2/19/2003 11:38:37AM City of Springfield Development Services Depa.. (ment Public Works Department Official Receipt How Received Amount Paid In Person In Person 51.75 0.90 $52.65 Payment Total: cReceipl.rpt