HomeMy WebLinkAboutPermit Electrical 2003-01-13Gity of Springfield
Electrical Perm it Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
541-726-3676Fax
541-7 26-3769 Inspection Line
PERMITNO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00011
u13t2003
u13t2003
7n3t2003
SITE ADDRESS:
ASSESSOR'S PARCELNO.:
PROJECT DESCRIPTION:
420 26TII ST
1703361418100
Change service
Springfield
TYPEOF WORK:
TYPE OF USE:
Repair
Residential
OWIIER/APPLICANT:
JIM EASTBURN
PO BOX 310
SPRINGFIELD OR97477
ELECTRICAL CONTRACTOR:
BURRELL BROS ENTERPRISES INC 541.747-2724
40159 BOOTH KELLY ROAD
SPRINGFIELD OR 97478
CCB # 136446 Expiration Date: 0812012003
Description
+ l0% Administrative Fee
+ 7o/o State Surcharge
Perm ServiIdr 200 amps or less
Amount Paid
6.30
4.41
63.00
Date Paid
0Ut312003
0U1312003
0Ut3/2003
Receint Number
1200200000000000528
1200200000000000528
1200200000000000s28
To Reque$ an inspection call *re 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.m. will be made the following working day.
Required Inspections:
1 Electric Service: Approval required prior
By Signature, I state and agree, that I
information hereon is true and
with the Ordinances of the City of
further certify that only con
further agree to ensure that
company energrzlng serylce.
examined the completed
certify that any and all
the laws of the State of
who are in
pections are req
if applicable, will
10
that all
e in accordance
described herein. I
this projecl I
readable from the
street, and that the a
Owner or
\(\
I of I
t/13/2003
8:13:35AM
City of Springfield
Development Services Departm ent
Public Works Department
Official Receipt
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
Receipt #z 1200200000000000528
Date: 0111312003
Line ltems:
Job/Journal Number Description Amount Paid
ELE2003-0001 1
ELE2003-0001 l
ELE2003-0001 I
Perm ServlFdr 200 amps or less
+ lUYo Administrative Fee
+ 7%o Slate Surcharge
Payments
63.00
6.30
4.41
Line Item Total:$73.71
Type ofPayment Paid By Received By Check Number Confirm No How Received Amount Paid
Check BURRELL BROS djb In Person 73.71
Total:$73.71
Page I of I cReceipt.rpt
CITYOFa+FIELD, ORSGO}I
225 FIFTH STREET . SPRINGFIELD, OR9747'7 o PH:(54
E L E CTRI CAL P E RM IT AP P LI CATI O N
Cit-v Job Number (ae Zc'ciS ooo I I Date
I
LEGAL DESCRIPTION A.
33L 8tcn
JOB DESCRIPTION
Permits are non-transfera ble and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 daYs.
7
Electricai Contractor
Address Burrell Bros. Electric
40{59 Booth KellY Road
Springfield, Oregon 97 478
\\\_a\l\Ciry
Supervisor License Number S
Expiration Date
Constr. Contr. Number
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
Installation,
EOB
Volts see "B" above.
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
0
has the tollowing
land use
L ft
l- |e@
$50.00
\ $ 63.00 L3,*
$ 75.00
$ 1 25.00
$ I 63.00
$3 75.00
$ 50.00
$ s0.00
$ 69.00
$100.00
$ 43.00
$ 3.00
00
00
00
00
Fee is $45.00 + Surcharges
b=
,-{'1 {
9e)
13'L
\^.-
apProval
Zoning
Service Included
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
B.
/>
Expirarion Date
ignature of Supervising
Name
Address
Phone
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Signature:
in
Minimum
7o/o State Surcharge
10% Administrative Fee
TOTALIrrspection Request: 726-37 69
4.
Shared Driv{T:/Building Forms/Electrical Permit Application I -03.doc
Of,
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$ 106.00
$ 19.00
3.
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