HomeMy WebLinkAboutPermit Electrical 2003-2-18
225 FIFTH STREET. SPRINGFIELD, OR 97477 · PH:(541)726-3753
ELECTRICALPER111IT APPLICATION
City Job Number ~JE..~Oi>,?/cmJo7 Date :2..-/<6-D3
eel as submitted has the following
s not require specific land use
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LEGAL DESCRIPTION Al'TtNlI0N:UreOOn';,i,~~~~~~~ir~~~ti
les adopted t:)y the eJregon ,
3 2. , CeN 71:""t..JJI , A-t.. fo~~~ ,., ter TRQI2vJceJBgl!.q~set fort!
NotlTlCallU11 ven . ,;:' I ^ n Q52 001
JOB DESCRIPTION, , OAR 952_001-00101t~l~eb~,g}~f{.1I\lt€SS ,- ,
'7 " - l -, In 0 You may ot:)tairlf~,c~~ffip\i~ttQrlchf5(1'@lk~?fP.0r
Cl {2..c........'.... \ "~ 009 :.. _ ...."... center r.~W: ~fl~e..~ephone ,
l,;i:llllll~ l""" . , ., N ifil"'ation
Permits are non-transferable and expire~if,\worlkriSor the OretR@ehlAA~HUfac'?Y H'omeor
,llu "......... . - I' "\
not started within 180 days of issuance or if worID~!!"tP' i~,l-~M6'dHra1?':6\?etlhrg Service or
Suspended for 180 days. Feeder
Supervisor License Number 3 7 f'f 5
10- o4..f
/ 200 Amps or less
-'? / 0 g , 201 Amps to 400 Amps
NOTICE: 401 Amps to 600 Am s
THIS PERMIT HA EXPIRE I E WORK
AUTHORIZE.Q
COMMENCt'D
ANY 180 DA~e'RillfJ.ation or Exte~sion Per Panel,
One Circuit I
Each Additional Circuit or with
Service or Feeder Petmit
1.
:'8
EleCtrical Contractor 71 ~ I Jr;.J DA '1 f'LE llJ G
Address J- Cf ( o,e eft ~ \ ) (aim,
r 01(. rt I b
G::ity Y'1 t)) ~f<.~ Phone 9 " L.J 826>
, ,
Expiration Date
Constr: c::ontr. Number
Expiration Date
O}- oC-(
Sign",uc, OfSUP',J'\, liS,;ng EI"{J,tttioi; , '
/~.~ "
-
,
- Owners Name S{?t::-i2> SC.HOOL ~)S.I
Address 5Z 5'" J--v'1 / L L 'S r
City S P (~'b. Phone 7'it.{,- (;37:;-
OWNER INSTALLATION
The installation is being made, on property I own which
is 'not intended for sale, lease or rent.
Owners Signature: 'g' ""
Lf4 '" '
.A~
- - - - ~ y
Inspection Request: 726-3769
,~
3.
$106,00
$ 19,00
$50.00
B.
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps ,
601 Amps to 1000 Amps
Over lOOO Amps/Volts
Reconnect Only
$ 63.00
$,75.00
$125,00
$163,00
$375.00,
$ 50.00
c.
Installation, Alteration or Relocation
$ 50.00
$ 69.00
$100.00
$ 43.00
L,AS
i g'
6
$ 3.00
E.
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50.00
$ 50.00
$ 25.00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
/',1'
\So'
l(Z-7
bID
71'~7
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive(T:)/Building Fonns/Electli~al Pennit Application I-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00037
ELE2003-00037
ELE2003-00037
ELE2003-00037
Payments:
Type of Payment
Check
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 2200200000000000488
Date: 02/18/2003
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
BRIAN DAY ELECTRIC
Received By
Check Number Confirm No
1640
Ikw
Page 1 of 1
2/18/2003
1O:23:07AM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
Amount Paid
43.00
18.00
6.10
4.27
Line Item Total:
$71.37
How Received
Amount Paid
In Person
71.37
$71.37
Payment Total:
cReceipt.rpt
. ....
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:
ELE2003-00037
2/18/2003
2/13/2003
8/18/2003
SITE ADDRESS: 326 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO.: 1703263406200
Springfield
TYPE OF WORK: Repair
TYPE OF USE: Public
PROJECT DESCRIPTION:
Lighting Upgrade
OWNER! APPLICANT:
SCHOOL DISTRICT #19
525 MILL ST
SPRINGFIELD OR 97477
,ELECTRICAL CONTRACTOR:
BRIAN DAY ELECTRIC
298 ORCHARD VIEW TERRACE
MEDFORD 97504
CCB # 81081 Expiration Date: 01/01/2004
Descriotion
Amount Paid
Date Paid
Receiot Number
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
6.10
4.27
43.00
18.00
02/18/2003
02/18/2003
02/18/2003
02/18/2003
2200200000000000488
2200200000000000488
2200200000000000488
2200200000000000488
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 a.m. will be made the same working day,
inspections requested after 7:00 a.ill. will be made the following working day.
Reouired Insoections:
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 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
1 of 1