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Home My WebLink AboutPermit Electrical 2003-08-01City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00183 81u2003 8t1t2003 2nt2004 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 1267 34TH ST 1702303409s01 MH service TYPE Springlield OF WORK: TYPE OF USE: Alteration Residential OWNER/APPLICANT: POLSLEY GARY DENNIS 874 23RD ST SPRINGFIELD OP.97477 ELECTRICAL CONTRACTOR: ROB'S ELECTRIC s4t-686-s444 2155 OHIO STREET EUGENE OR ccB # 146149 97402 Expiration Date: 09 125 12004 Description + l0% Administrative Fee + 1Yo State Surcharge Manufactured Home Service Amount Paid 5.00 3.50 50.00 Date Paid Receipt Number l 20020000000000 1 87s I 20020000000000 I 875 1200200000000001 875 112003 v2003 To Request an inspection call the 24 hour working day, inspections @ftnspections requested before 7:00 a.m. will be made the same following working day. utility company energizing service.1 MH Service: By Signature, I state and 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 used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each from the street, and that the approved set ofplans, ifapplicable,will remain on the site at all times . t. )\\bt the n€a(eoI Paee 1 of I saSefID \ Owner or Contractors Signature 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department ELE2003-00183 ELE2003-00183 + l0o/o Administrative Fee + 7Yo State Surcharge 5.00 3.s0 Item Total:$58.50 Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid CreditCard DAVID LAWLER djb 000134 001632 In Person Payment Total: $58.50 $s8.50 225 FIFTH S-TREET . SPRINGFIELD, OR97477 . PH:(541)726-3753 o E LE CTRI CAL P E RM IT AP P LICATT O N I c, 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 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 ( Zoning &tL or Relocation Amps or 1000 Volts see "B" above. \ has the tollowing specific land use $ r 06.00 $ 19.00 $50.00 ;c) $ 63.00 $ 75.00 $ 125.00 $163.00 $375.00 $ 50.00 $ s0.00 s 69.00 $100.00 50.00 $ s0.00 s 2s.00 5o 1 3 B. D E. Minimum tZ 6'7 <*^ s* LEGAL DESCRIPTIONt'\oL3O3'{ o ?so1 JOB DESCRIPTION /$ t+ s€{Li i L{5 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. A. I ", Electrical Contractor ,%;s El"4r,. Address Zt f S- Oil,b 5/. Crry E-7"t^t Phone /{d r/,/ Supervisor License Number '1 7 ya-s Expiration Date lo-ot C. ?-zf ol Signature of Supervising Electrician New Alteration or Extension One Circuit Earyh Additional Service or S S?rb, phone OWNER INSTALLATION The installation is being made on property I own which is not intended for saie, lease or rent. Owners Signature: 2r, 4'00 Owners Name G**' Pu!-- tz6-7 3t1+4 s+-Address City \e $ 45.00 Inspection Fee is $45.00 + Surcharges .Sr.IBTATAL OF ABAtrE .. -7 5-<) 5ao 7oh State Surcharge 10% Administrative Fee TOTAL *s8': oe Inspection Request: 726-37 69 4. Shared Drivc(T:/Building Forms/Electrical Permit Application 1-03.doc constr. contr. Numb ", fup- 116 /t/1 Expiration Date