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Home My WebLink AboutPermit Electrical 2003-08-19City of Springfield Electrical Permit Attachment Status: lssued 225 Fifth Street Springfield, Oregon 97477 541,-726-3759 Phone 541-726-3676Fax 541-726-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00191 8n9t2003 8n9t2003 2n9t2004 AY Springlield TYPE OF WORK: TYPE OF USE: N on Ut the telePhone ility Notification 932-2344\ Amount Paid 4.90 3.43 43.00 6.00 THE WORK 3ts7 Description + l0o/" Administrative Fee + 7o/o State Surcharge Add. Alter. Extend Circ Add. Alter. Extend Circ Ea Add 120 EU CCB Date Paid 0811912003 08n9t2003 081t912003 08n9t2003 03lt Receipt Number 220020000000000141 1 220020000000000141 I 220020000000000141 I 220020000000000141 l NDO l1 To Request an inspection call the 24 hour recording at726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following working day. Required Inspections: 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 set of plans, if applicable, will remain on the site at all times during construction. Owner or Contractors Date Pase 1 of I SPBIHGFI&'I b SITE follow r rules are set 54t-344-3561 7/2007 damage L 1l H IrJ 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department #z 220020000000000 I 4 1 I Date: 0811912003 2:17:39PM ELE2003-00191 ELE2003-00191 ELE2003-00191 ELE2003-00191 Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + l0%o Administrative Fee + 7%o State Surcharge Item Total: . 43.00 6.00 4.90 3.43 -$ffi Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid CreditCard JACKDEAN 000147 019241nJm In Person Payment Total: $57.33 $57.33 225 FIFTH STREET . SPRINGFIELD, 4R97477 r PH:(541)726-3753 o FAX: (541)726-3689 ha? API}LTCATTO}T Ciry Job )\"Date -t BS a(oY:o\ doa' q ) 1. LOCA?TON TNST'AL ?IS"M 3. 2 I 57 LEGAL DESCRIPTION A. Nerv Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder 601 'aruil1' per rlueliing unit. $ 106.00 $ r 9.00 $s0.00 $ s0.00 $ s0.00 $ 2s.00 $ 4s.00 t JOB DESCRIPTION J /" Permits are non-transferable and expire if rvork is not started within 180 days of issuance or if work is S uspended days. City EUGENE Phone 344-356L 10925 Supervisor License Number Expiration Date LOIOLI03 Consh'. Contr'. Number cc890200 Expiration Date 3lL7 lO7 Signafure of Superuising Electrician ,L B. Sen,ices orpFarqryqhdrctdtsttb$, Alterations or f{elc}cation: Springfield Bronch zoo ffis6pfigNA1 BANK OF OREGON$ 63.00 zot ,apps@ffisttnpfrly I 536 Ol45 ^S $ 7s.00 40lAmpsto(ffiSpgpRlt{GFIFLD $12s.00 rq\$ *ES $163.00 r ldw;eQUtre*yfl$& try t hECIeO c.Ur#lolit y e$or rca Center. Th ose rll es are set fort Pump or irrigation Sign/Outline Lighting Lirnited Energy/Residential Limited Energy/Commercial Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. SLIBTOTALOFABAI,'E $'jT s C L C. TempnrarS' Sen,ices or Fe*tlers rn.t"rg?i[h$[b${imtgf .r{.gtrdnidh e re te phone nurnb,er for the Oregon Utility Noti$E6ffin ;:? ffi: lJ Hrixfil,s r -a'oo sb?#)lil u,,o 401 Amps to 600 Amps $100.00 Over 600 Amps or 1000 Volts see "B" above. D. llranclr Circuits Nell'Alteration or Extension Per Panel One Circuit $ 43.00 Each Additional Circuit or with E. ft'tistellaneous {servicelfeeder rtot includedJ *Each lnstaliatiort Owners Nan.re Address (- ? \pc)City Phone---r-- OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 'q 5a 3.q'7o/o State Surcharge l0% Administrative Fee TOTAL 4 "1,- {=. ci-slnspection Request: 726-37 69 Shared Drive(T:)/Building Fonns/Electrical Pennit Application l -03.doc o L , ctmfftfter&ro5{,v,gr4LLAggN,f,{ir',. AUTr"iOfi iz[u !.,luceneerecUiir,€ i.u iE I ectri&[iffi ffi eE D 0 ;j ls- I'b',-i ffi;'J ;u R ooo..fNy 18.&m[,ruftn0; "!vv^Lr./ I