HomeMy WebLinkAboutPermit Electrical 2003-7-15
-"
06/06/03 FRI 10: 34 FAX 5417' '689
CITY OF SPRINGFIELD
141001
;"
submitted has the following
225 FIFTH STREET . SPRINGFIELD, OR 97477 _ PH:(541)726-3753 _ ~f.l(~1.iW-~~ require specific land use
approval. I'l ", .
ELEl;lKICAL PERMl1'APPLIJ;,4.TION . . ~
City Job Number E.LeZoa3~ 00 j eb Date 6/6/03 . _ ZOning 'i-fs--a 3 ~
1.:~:L(j~~TIQ&:Qf~sr4t~~~:q9i\i<.:. ..:.::. 3. :::"9g~~F;~;~~~~~.~r).~::');;: ....... ..,'.
900 Beltline Road, Springfield
LEGAL DESCRIPTION
j7D3.1 S3 0
()J'OOO
A. ::~~',{R~~i~~~~~#~I~..S~lJ~f~tii~~f#i~~~:~Vd:~~~l~~~~'~@'i:i;;i.:
Service Included
1000 sq. ft. orles$
Each additional 500 sq. ft. or
portion thereof
$106.00
Shari's Restaurant
JOB DESCRIPTION
Install electrical for lottery conversion.
$ J9.00
Permits are non-transferable and expire if work is
not started within 180 days of issnance Or if work is
Suspended for 180 days. .
2. (S?~fq~.i~r1~~3iq~:~~~;i';.
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
$50.00
B. '-i:~~f~;~4~~.-~~!r~~~;~t~..H:f~i~IJ:~~?~:;~~~#.te#~~~.:~.~'*~~~~.~#~~'~;-_.!i'!.
Electrical Contractor
Atlas Electrical Contracto1200 Amps or less
201 Amps to 400 Amps
40 I Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 AmpsN olts
Reconnect Only
$ 63.00
$ 75.00
$125.00
$163.00
$375.00
$ 50.00
Address 440::\ SF: RoptQP Roao. __~
Milwaukie, Oregon 97267
Phone (503) 659-2212.
City
c. .:T~'.."'Yi~~~~~.'F~ciI'ers.; ."~;~~:::':~.:::::~.:::'_;':>::.::.:".:::.:';<:>.''::''"
~~':fT... ~. ..-.... ... ,....... ...... '.. - _- ...-
~ ~e~(PA~, :\;\~', J
10/1/04 (){\\'lJ. ~e~,~~~hon orllelocation
.O''O~ ....~'1'\l -~\B~:fr1~!A.~' $ 5000
O~. ~ev- Se t!W Vlp.>~ r ,U""" -
ConstL Contc Number 1532 _'\;;~\~" 0..009 :~O ~~Q}'~~~~&\ $ 69.00
~ \ ~,\)\evce~~'\()~ of~~~ps $100_00
Expiration Date 9/3/03 ~o~~""t-\~~,,~'\ o~\~~ ~dSf' ._ ~~~r l~~~ yol~s s~ "~"I.~bo.v~:y. d.. . .._. . ,.,..,.._.
S. fS. - - EJ . NO bo.?9 A\e.'1_...de\ ,~^' 'Irl"'ut~ "'" " ..' .-.... -" ..,. ',', ' ..;
Ignatureo upelv1sll1g ect1'lc~10""~""o\)"'eC"".'O\~v... .. ;.' ;:'-. ~-"'_-,.-'.':. ..-':',,":'_.-'-.-; . ':", .' -'. ,"'-, ._'._;,'...
: iJ . . , f) ~ otf!J3' ~\v:4 \~ ~ \"(\0. '\ ..~ew Alteration or Extension Per Panel
';( )/. U/~_ c:fI) ~e'\C}eO~'\S One Circuit _ -l- $43.00 ~].(;O.
(\\)~ VO' Each Additional Circuit or with 5' 4!"'"
Service or Feeder Pennit A $ 3_00 -CIZ.ocr /.:>
Owners Name Shari's Manaqement Corpor_ation ~'&
Address 8205 SW Creekside Place E. '~~~~~ri~~~{(seI1;j~~~~-f;~iud~dj~E~~h,i~~,t.~.~~tio~'-
- .. . ,.' .,. """ . - ~\'\\t,\VT~~\" \'d,\~\rJ;- . ...,. ,,,-
Phone (503) 605-418_5 C~. pump~~\\\<;, ~t.~ x.\) ~a~ $ 50-00
~\)"'\ ~~O'~~\)Q~ $ 50.00
OWNERINSTALLATTQN \~\S ~;~~~~t\i~sidential $ 25.00 _~N_'
!be ~tallation is bein2 made on property T own which ~\J\ ~~ie~t~inmercial ,,1 _ $ 45.00 545.00
18 not mtended [or sale, lease or rent C~i~\lfectric Permit Inspection Fee is $45.00 + Surcharges
Owners Signature: . ~~. i~:.~~~?rM::e~~g~<:';:-/{:L:;;j'_;':'jj);-"iii'i;;.i/;;i _100 _ 00
Supervisol' License Number
2581S
Expiration Date
City Beaverton
7% State Surcharge
10% Administrative Fee
6,0
-=t-:-OO '1 zo
-J:O .00- b.o
~~'7~1>70 ~
Inspection Request: 726-3769
TOTAL
Shared Drive(T:)/Building FormslElootrical Pcmlit Applicatio1lJ.03.doc
City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.: ELE2003-00166
ISSUED:
APPLIED:
EXPIRES:
7/1412003
7/14/2003
1/14/2004
. SITE ADDRESS: 900 BEL TLINE RD
ASSESSOR'S PARCEL NO.: 1703153001000
Springfield
TYPE OF WORK: Addition
TYPE OF USE: Commercial
PROJECT DESCRIPTION:
Install electrical for lottery conversion
OWNER/APPLICANT:
SHARI'S OF N SPRINGFIELD
% SHARIS MNGT,CORP
BEA VERTON OR 97008
ELECTRICAL CONTRACTOR:
ATLAS ELECTRICAL CONTRACTORS 003-659-2212
4403 SE ROETHE ROAD
MILWAUKIE OR 97267
CCB # 1532 Expiration Date: 09/03/2003
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee 6.00 07/14/2003 1200200000000001756
+ 7% State Surcharge 4.20 07/14/2003 \01200200000000001756
Add. Alter, Extend Circ Ea Add 15.00 07/14/2003 es'iO~~\\~00200000000001756
Low Voltage - Commercial Indus 45.00 07/14/2003 '(eo..U\~"of\" :~'n200000000001756
'fJ-..H C1- _.\:~
0"\ ~"nce fA,\~~,N"!,'
To Request an inspection call the 24 hour recording at 726-3769. ~~~~I~'4etlU~~'e~~,~.wi1l be made the same
working day, inspections requested after 7:00 a.m. will be m'!~il\~~a~~~~~O~\'(\8 ~~
:,,"\~ fl\eS re.t. e'~ .e-O\ ~t~-ilf1(\
~\O"" ~ \J J:P' CO'Y' (i\e '\: ~'(\V'"
ReQuired Insoections: ~ ~\\\c&.\w,~$'\ O'O\~(\ ~o\rI' ~~\-\~;'\.
1 Rough Electric: Prior to Cover ~O O~~ ~ou <<,e.~\e\,~o(\ \)~ ~'l.~
2 Final Electric: When all electrical work is comPI~%da().~\\(\~\"~'(\,,eO\..~O()"~
3 Low Voltage: Prior to cover. ~ ~'( \0 ~\e'( \S
'(\u'#:\ oe
By Signature~ I state and agree, that I have carefully 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 Shi~'ih)lle in accordance with
the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to t~~ ~~\ribed herein. I further
certify that only contractors and employees who are in compliance with ORS 701.0~~\~le~~-ep this project. I further agree
to ensure that all required inspections are requested at the proper time, th~~~~<3'b.Tt~S~hW~ rom the street, and that
the approved set of plans, if applicable, will remain on the site ~~lim~ ~:::\nlfi~~~~~~
~~" '?~~~' \) \)~\J ,S ~<o~
...u\S ()~,1~ - f)~ R)~
Owner or Contractors Signature \ ~\.)\~ ~~~c,~~Ci(<t.\\'\
c,(J~ \ 'O~ \)~
~~'{
Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00 166
ELE2003-00 166
ELE2003-00 166
ELE2003-00 166
Payments:
Type of Payment
Check
Receipt #: 1200200000000001756
Description
Add, Alter, Extend Circ Ea Add
Low Voltage - Conunercial Indus
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
ATLAS ELECTRICAL
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 07/14/2003
2:33:10PM
Amount Paid
Item Total:
15.00
45.00
6.00
4.20
$70.20
How Received
In Person
Payment Total:
Amount Paid
$70.20
$70.20