Loading...
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 9LD d---l%'-O~ )(, IIIJn1 L I tJ ~ IZ>PLf= Sc!/ 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