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Home My WebLink AboutPermit Electrical 2003-07-14225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o E LE CT RI CAL P E RM IT AP P LI CATTO^r CiryJobNumber EL€ZoOJ-oC.l/65- ou," c> ? / q O'3 apProval submitted has the lollowing require sPecific land use Lua Zoning -a3rl-15 1. LACAT'ION OF INS'TALIATION ziLlo 5+'' =+_ 3. caMPLg"IE"rp-.{blpJ{6rddd{ul6 A. Nerv Ilesidential - Single or Plulti-Farnily per drvelling 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 unit"LEGAL DESCRIPTION tf o'32 bz.l of ?oo r JOB DESCRIPTION ZOC)A 5 ?{ t- -L*'.a s r 06.00 $ 19.00 Permits are non-transferable and expire if work is not started u'ithin 180 days of issuance or if work is Suspended for 180 days. 2. }0NTRACTOR TNSTALI-LTrON ONLY Electrical Contractor --T A,.^ t € ie v Address f?o t\u efi City €,o^r- 02 ,i a14o 73 z- t uLPhone Supervisor License Number e Expiration Date S a1 Constr. Contr. Number Expiration Date /?oL O'f Signature of Supervising Electrician Owners Name E LA tuA LA'Zllo 5-+\^ Sfl;lN nhone $'$ OWNER INSTALLATION The installation is being made on property is not intended for sale, lease or rent. Owners Signature: $s0.00 B. Sen,ices or Feeders - Installation, Alterations or Relocation: er->200 201 401 Amps Amps or less $ 63.00 s 7s.00 $ 125.00 $ 163.00 $375.00 $ 50.00 $ s0.00 $ 69.00 $ 100.00 or Feeders or Relocation D. Branch Circuits New Alteration or Extension Per Panel $ 43.00 $ 3.00 not inclutled) -Each lnstallation Address City $ s0.00 $ s0.00 \$0 Energy/Residential $ 25.00 Limited Energy/Comrnercial Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. SLTB:|OTAL OF ABOI.'E $ 4s.00 L) Llqt 7oh State Surcharge 10% Administrative Fee TOTAL ' 3oe 73 z!-Inspection Request: 726-3769 I own which Shared Drive(T:)/Building Fonns/Electrical Pcrrnit Applioation l -03.doc nrSrcrE OREGON Eate or less to 400 Amps 401 Aurps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. One Circuit Each Additional Service or \S \t\,'^ 1$\) W City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3616Fax 541-7 26-37 69 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00165 7n4t2003 7n4t2003 u14t2004 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 2140 sTH ST 1703262105900 200 amp service change Springfield TYPE OF WORK: TYPE OF USE: Alteration Residential OWNER/APPLICANT: LAWSON ELAINA 2I4O N 5TH ST SPRINGFIELD OP.97477 ULLMANN A J 2I4O N 5TH ST SPRINGFIELD OP.97477 Description + l0o/o Administrative Fee + 7o/o State Surcharge Perm Serv/Fdr 200 amps or less To Request an inspection call the 24 hour recording at working day, inspections requested after 7:00 a.m. will the following working day NTRACTOR: 541-232-1212 Date: 0211112005 Receipt Number 220020000000000 1 24 I 220020000000000 I 24 1 220020000000000 l 24 1 requested before 7:00 a.m. will be made the same THINK E 6.30 4.41 63.00 \(\\\i\o Required Inspections: 1 Electric Service: Approval required prior to utility company energizing service By Signature, I state and agree, that I have carefully examined the completed information hereon is true and correct, and I further certify that any and all the Ordinances of the City of Springfield and the laws of the certify that only contractors and employees who are in to ensure that all required inspections are requested at the the approved set of plans, if applicable, will remain on the Owner or Conffactors Signature Date certify that all in accordance with described herein. I further used on this project. I further agree is readable from the street, and that Paee I of I trSlaxlla 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department Receipt #: 220020000000000 124 I Date:07tr4t2003 lz32:22PM ELE2003-00165 ELE2003-00165 ELE2003-00165 Perm Serv/Fdr 200 amps or less + l0o/o Administrative Fee + 7Yo State Surcharge ltem Total: 63.00 6.30 4.41 -$E r Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid THINK ELECTRIC THINKELECTRIC djb djb In Person In Person Payment Total:$73.71 $74.00 (so.2e) ELE2003-00165 ELE2003-00r65 ELE2003-00165 Perm Serv/Tdr 200 amps or less + llYo Administrative Fee + 7o/o State Surcharge Item Total:$73.71 63.00 6.30 4.41 Payments: Type ofPayment Paid By Received By Check Number Batch Number Authorization Number How Received Amount Paid Cash Change THINK ELECTRIC THINK ELECTRIC djb djb In Person In Person Payment Total: s74.00 ($0.2e) $73.71 Cash Change