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HomeMy WebLinkAboutPermit Electrical 2003-3-13 " 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 ELECTRICAL PERMIT APPLICAI10N City Job Number !::LC;:C:t:..-) 3- 0 () 0 7 / Date _ ' as submitted has the following . FAXJll(~I~"a(~"'ot require specific land use approval 1. <644 LEGAL DESCRIPTION ~703 /S3C) JOB DESCRIPTION Cjt) (0 G , c::::; C\ t J)('r 1 i '1 " 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 Contractor L I let:, ') C jc-{ -h It /, (' Address jCic) I,,-,tuc\ \ >J( ~) City [ _ L~)(Y)~ LIQC I (I:}") Phone t 'y:) '- ,- ',~, Supclvisor License Number ~ 1 Cj () Expiration Date I (J - I '(I lJ '- J Conslr. ContI'. Number ,',...)<] (f? Expiration Date J':.). i I} - 0 .~ vising Electrician j /-.. <;;. Y G,.t1 p~( is'- C ulZ- P Owners Name M OAf'\nq.Q( ---dJ../ (l Ilh CU.A{J Address ;?5'-< 0 '~f+((~t- ad s ~ /;::~ City Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owncrs Signature: Inspection Request: 726-3769 Zoninr ~ 03, ISO '3 3ate :~-(f<; -o~ \ 3. C()MJ>LE'1'E:F'bift&tlH~"JM.r}IfMtBilibl~l'~~) ::'~:: :.,.: . . ..., . ;"; ','<-':: <,- . - ...: ".' -",:,: :",' ":: i _' ~: .: .. ".t~'" .'. ." ': ..:,-,:.. :;': ,':.'-"'.' ;.-.. ,.".. '.:' .'., .:.../,:<-, ,. >. :':' :.:' :"""" .~' '.-':::' , , A. New Residelltial- Single or Multi-Family per dwelling unit. ", Service Included 1000 sq_ ft. or less Each additional 500 sq, ft. or pOl1ion thereof Each Manufact'd Home or Modular Dwelling Selvice or Feeder $106.00 $ 19.00 $50.00 B. Scnices,or Feeders - Installation, AHenltions orRdocation: 200 Amps or less 20 I Amps to 400 Amps 40 I Amps to 600 Amps 60 I Amps to 1000 Amps Over 1000 Amps/Volts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375,00 $ 50,00 ',,";,;r~j ~~>' .:-.' -,\,.'.,\\A ~f"'\:-i,t~~:' ~()~l '~",:~~~?- ~();')~-,:' C. lTen~1'9"l1rY-~f<!i\\ice~8I<E:l1eq~r\S)';1"'~\(fl"~Y' ,\('.oy."'"''',., \\\\':'("'\~-'\"<" .',r' I n,s;tl'iIla tin'liAi (el'a'fib'ii'o (R'cltl~a tio\rt ,~: ' -' ___,\;.._.:\l-..\ ...-\,-.\'i"'" ',,' I"'! ""'C' ~"~,..:.-... f!~O)An1Pw.dl\'le,ss('!Y-:' . \_', . - . _,n " ,~' 2(),I:^lnp;~)t~~~~Ogc0'hl~sr,r.r:' \ . 4ql\A H1l?;ttQ oqQ\AntJ'1's " ," , t. D. $ 50.00 $ 69,00 $100.00 New Alteration or Extension Per Panel One Circuit I $ 43.00 4- ~ --- Each Additional Circuit or with 4'-)~ Selvice or Feeder I'cnnit --.~ 'flO~'OO J d' E. '~1i~~~ii~)ie~us .(ser~'i~~,'$~~~~l~~'~hiliS~~Ii~ti~n \C~. S\\~\..\.. '\\\\S V '~\) to ~~Q1 b~~\11\)~\)t.~ ~~~\)O~ $ 50,00 Sit~~~~~llll~ \S ~ $ 50.00 Li*~,~1J\~~~~i~\6~\)' $ 25.00 Lim~.j~~mmercial $ 45.00 ,~, Minimum f<Jectric Permit Inspection Fee is $45.00 + Surcharges 4. s- )~~ '3 #&5 f).. SO bi~ 7'% State Surcharge 10% Administrative fee TOTAL Shared Drivc(T:)/Building Fonns/Elcctrical Pcnnil Application I-03,doc ~ City of Spr~ngfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfiel~ Cffegon 97477 541-726-3759 Phone 541-726-3676 Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00071 3/13/2003 3/13/2003 9/13/2003 SITE ADDRESS: 844 BEL TLINE RD ASSESSOR'S PARCEL NO.: 1703153000900 Springfield TYPE OF WORK: Addition TYPE OF USE: Commercial PROJECT DESCRIPTION: Add 5 circuits OWNER! APPLICANT: SYCAN B CORP 840 BEL TUNE RD STE #202 SPRINGFIELD OR 97477 ELECTRICAL CONTRACTOR: BUILDERS ELECTRIC INC 541-485-0922 195 MADISON ST EUGENE OR 97402 CCB # 4296 Expiration Date: 12/10/2003 Reouired Insoections: ~...- ,Date Paid ~eS '10 .Receipt Number )J.\\ v" ~ 03/13/2003 .. ~ :\e~ :\e~0~220B~~~000000000592 03/l3/?9q~00 \'0: \'(\e 0 s 0.'\~~@J2b~~0!)Q0000592 0,3('J:J'l.209feo. '0'1 5e ,\).W O\>-~-2RQ~000g0000000592 " ~'03113i400\ ~'(\O ~O\}~'(\ 0\ ~2002.Q,Ol>9'O~P0000592 /\ ~ \DS _~P.' _ ~'<\\ . _c, .\P.'O .HO p.' '(v' C~\"' f.\"\v' :Q\~ ,"v' .<- v"" To Request an inspection call the 24 hour recording at 726-3769. All iri~p-~~tioBS\feq'uestJ~hjefOl;,e 9fooLa:ih~\tiJ.l~b-~~de the same working day, :\V' ,'O.\,\~ \)\J . ;to.' 0'""'" " p inspections requested after 7:00 a.m. will be made the following work'ing{oay-,- 9JS'2: n."o\:5 :\ ~ \)\~\"\1 () f>tb.')' ~u. r....~ ((\c-'1 {\\e' O~ :t:'t-;J _ Or .....In\). _ r.e ~~P.~ . 0..'5 \" 9'V" \\ \~ e""" . CQ'V\,) ()(j ~\\~'Y> \O'\\~ \,b '\~ c ~e'\ {\\0'\ '(\\).f0 Ce 5.50 3.85 43.00 12.00 Descriotion Amount Paid + 10% Administrative Fee + 7% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add 1 Rough Electric: Prior to Cover 2 Final Electric: When all electrical work is complete. By Signature, I state and agree, that I have carefully examined the completed application and do hereby cert.if~~t all information hereon is true and correct, and I further certifY that any and all work performed shall be ~~llil ~dance with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining_t9J ~r ~~i ed herein. I further certifY that only contractors and employees who are in compliance ~i.tl! ORS 70~~~1 C!?~~ RD{f.b% project I further agree to ensure that all required inspections are requested at the~t\bjrer le~~(fJff~~~~'yeadable from the street, and that the approved set of plans, if applicable, will remain on'\\ne \i~~~ ,tiJ'd"\(JR-ri~W;nstruction. ,\(So ~sr \> \J~ \~ ' ~\,,() c,'t.\) ~\C)\). ~ -, ~~~ 'IOY- te~\\~~. \)P-\' ~ ..J \ ro~ ~~, Owner or Contractors Signature I of 1 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Line Items: Job/Journal Number ELE2003-00071 ELE2003-00071 ELE2003-00071 ELE2003-00071 Payments: Type of Payment Check Paid By Description Add, Alter, Extend Circ Receipt #: 2200200000000000592 Date: 03/13/2003 Add, Alter, Extend Circ Ea Add + 10% Administrative Fee + 7% State Surcharge BUILDERS ELECTRIC Received By Check Number Confirm No djb Page 1 of 1 3/13/2003 1 :30:39PM... City of Springfield Development Services Depa..t...ent Public Works Department Official Receipt Amount Paid 43.00 Line Item Total: $64.35 How Received Amount Paid In Person 64.35 $64.35 Payment Total: . 12.00 5.50 3.85