HomeMy WebLinkAboutPermit Electrical 2003-5-2
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, 225 FIFTH STREET
- SPRlrGFIELD, OREGv.~ 97477
INSPE9TIONREQ~~T: 726-3769
OFFICE: '726~3759 d,';:"f;.//""
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r 'TRICf::LP,EIWJT APPLICATION
City Joh NumbCI':,;,;;~l#4E~03'+,(g611 ~'
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S-::,<;:OMPLETE FEE SCHEDyLEI3ELO,W
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LEGAL DESCRIPTION
1'70 Z'39)>Lf () 5701
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Items Cost
Sum",
JO}PDE~CRIPTION /." '._ 1000 sq.ft. or less
,f( E,f}{l9-eE [)A-I1JA-GG D SG IJ... b '/(!B Eaclb<<~(pnal 500
fl9-ll/d., dna.s~,a!oC\isportion
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Pernuts are non-transferable and expIre 'c' as s\.I '{a spaCl\\fhereof
if work is not started 'within 180 ~~ing p{~: not {aC\\.I\ Each Home or
of issuance or if work is sUSp~~~M@\d dO ar
to al
180 days, a?\)fO\l' 'ng
lonl
$106.00
~ '. ': .:~
$ 19.00
$ 50,00
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2. CONTRACTOR INSTALLATION~ B,
" ,', oa\e. Signat\.l{a
Electrical' 60~i~acto~)'{L . R . Ip.16\!i\lb\fl~m , In c .
, ccs or Feedcrs.:',',:';';; .,.,,' \~;\6i,},;
~~~~~';:;~~' Altmti~~!.tf:j~,i,.,l,.,f,f,f.,!.:,',i,~,i'.$~".lj2,.i,~):'~O'~O... . ~~~
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, :y\:,';~i:':"'~l~$ 1.63':06":, ',\({;i!':
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Address:';~.:~n;we~:~k II Q II
CitySpr~~~,~i ~~;'~i::~JlOne
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S upervis()I;~iceiisel'h111~.ber
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Date
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""..,,', 7.7",rf ,"'",;".,' ,IJ/ /J
. . " ' "Phone",'" (p ,J
One Ci;6ui'{,
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. O\,"~iER INSTALLATION' :.,.... .~-:
,';,,' The installation is being 'nlade on ".,
property I o'i.\'ll whichis not intended
for sale, lease or reriC'"
Each Additional Circuit or 'rvith Service,',;:; ',"
or Feeder Permit ' ":' .t$ 3.00
NOT\CE: ' ' . ~:. EXP\RE\F THE WUtil\:( ,
1Hfs \'l1dRM!:rn~~ r:f\s,geprnMn itSlblti1lI)
UTHORlHi:blNi flbtlM,.,. 'ED FOR
A N.CIE1)~IDRrH:g,t~lij~NOON $50.00
COMME ~~t!RiOOghting , ,', $50.00
ANY 1802111llted EnergylRes $25,00
Limited Energy/Comm $45,00
, Owners Signatul"e:
l\'Iinimllm Elcctric Permit Inspcction Fee is 545.00 + Surcharges
~3J)O
~(i t/ J
~(30
13,''7/
4, SUBTOTAL OF ABOVE
7% Statc SUI'charge
/()~% Administratiyc Fec
TOTAL
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:
ELE2003-00115
4/30/2003
4/30/2003
10/30/2003
SITE ADDRESS: 1308 33RD ST
ASSESSOR'S PARCEL NO,: 1702303405701
Springfield
TYPE OF WORK: Repair
TYPE OF USE: Residential
PROJECT DESCRIPTION: Replace damaged service panel
ELECTRICAL CONTRACTOR:
LR BRABHAM
68 WEST Q STREET
SPRINGFIELD OR 97477
CCB # 8699 \0 Expiration Date: 12/18/2004
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Amount Paid ,~\paW;\ v \ \O~\ Receiot Number
\~'1\1'~ ()~e-J'" S0 0'"
+ 10% Administrative Fee 6,30 09P(\ \~@m30t2:gr03 S7:'a '0" 1200200000000001102
+ 7% State Surcharge 4.41 ~.0\ :\00 '0'1 E:.~3%~~ 9 '(\}\'dS 1200200000000001102
Perm Serv/Fdr 200 amps or less 63.00. ~ \ \0 ,?>00'Q ,,\~oS B~~l2'~~e '1(\.0(\0 1200200000000001102
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To Request an inspection call the 24 hour reo~~K~ ~"{e9~ 4.\~~\g:!,~~r~g~~ed before 7:00 a.m. will be made the same
working day, inspections requested after 7~~'@..~,o-w~1M €~e ~~Qb'&)I~~)\~~ay,
. f ()~~,(('\\) ~ . /"e(\\~ .00.0(\ fJ:n..?;'t-
\ ' 9\)'. W"" X\0v' ~~\J'-
ReQuired Insnections: ~~ c~\\(\~~\o~~ e~\S '\.
1 Electric Service: Approval required prior t~\~'?ty dO&~~ny energizing service,
OWNER/APPLICANT:
DONALD REGAN
560 S 4TH ST
SPRINGFIELD OR 97477
541- 7 46-0646
541-747-6638
Descriotion
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 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 use~s project. I further agree
to ensure that all required inspections are requested at the proper time, that each addreS\~~ ~~m the street, and that
the approved set of plans, if applicable, will remain on the site at all times durin~~~~\\ ~ t'l
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n'\\~~. ~\\ S\\ n~" '\~ >>\)\j~~
Owner or Contractors Signature \;~\S '\>~~\tt.\) B~ \S ~t '
~\J'\~ x..~Ct.\) ~t.,,\\j .
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Page 1 of 1
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield '
Development Services Department
Public Works Department
Official Receipt
Receipt #: 1200200000000001102
Date: 04/30/2003
Job/Journal Number
ELE2003-00 115
ELE2003-00115
ELE2003-00115
Description
Perm Serv/Fdr 200 amps or less
+ 10% Administrative Fee
+ 7% State Surcharge
Item Total:
Amount Paid
63,00
6.30
4.41
$73.71
Payments:
Type of Payment
Check
Paid By
LR BRABHAM INC
Received By
djb
Check Number Confirm No
How Received
In Person
Payment Total:
Amount Paid
73.71
$73.71
4/30/2003
11:51:58AM
Page I of I
cReceipt.rpt