HomeMy WebLinkAboutPermit Electrical 2003-07-22Gity of Springfield
Electrical Permit Attachment
Status: lssued
225 Fifrh Street
Springfield, Oregon 91477
54t-726-37
54t-726-3 ol!:oregori law requtres you to
541-72 by the Oregon Utitity
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00174
7t22t2003
7t2212003
u2212004
ose rules
TYPE
Springfield
OF WORK:
TYPE OF USE:
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OWNER/APPLICANT:
SPENCER LOUISE E
2I6 S 38TH ST
SPRINGFIELD OR 97478
Description
+ l0% Administrative Fee
+ 1Yo State Surcharge
Perm Serv/Fdr 200 amPs or less
E0edtroaBiitluLrr'iE tl -343-72g7
Amount Paid
6.30
4.41
63.00
EUGENE ORccB# 17252
Date Paid
0712212003
0712212003
0712212003
D.
Expiration Date: 02108/2005
Receiot Number
2200200000000001289
2200200000000001289
2200200000000001289
To Request an inspection call the 24howrecording at726-3769. All inspections requested before 7:00 a'm. will be
working day, insplctions requested after 7:00 a.m. will be made the following working day'
made the same
Required InsPections:
1 Rough Elechic: Prior to Cover
2 FinalElectric: 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 req uired inspections are requested at the proper time, that each address is readable from the street, and that
the set of if will remain on the site at all times during
LT c3
Signature Dateor
Page 1 of I
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lBgffi rules L
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PROJECT
construction.
225 Fifth Street
Springfield, Oregon 97 477
541-726-3759 Phone
City of Springlield Official Receipt
Development Services Department ,
Public Works Department I
Date:1:
ELE2003-00174
ELE2003-00174
ELE2003-00174
Perm ServlFdr 200 amps or less
+ l0%o Administrative Fee
+ 7%o State Surcharge
63.00
6.30
4.41
Item Total:$73.71
TypeofPayment Paid By Received By Batch Number Authorization Number How Received Amount Paid
Check nJm In Person
Payment Total:
s73.7r
$73.71
(
.2SFIFTIISTREET . SPRtr\IGFIELD, OR 97477 o pH:(S4t)726-3
City Job Date 2l
LEGAL DESCRIPTION VIW
.L o Signature
Service Included
1000 sq. ft. or less
Each additional 500 sq' ft or
portion thereof
C.
E;!i:::*
$106.00
$ 19.00
Each Manufact'd Home or
MoffiffprppEH fs6$ff I aw requr res Yot$So.oo
r.fdmw rules adopted bY th180 daYs.
Etre}'ftlql BsfiHltbi|
ANY 18 O OAY PE ,'J
Address 2r*15
Superv'isor License Number 4l:
L_J ZOS
Expiration Date
Constr. Contr' Number LO - lqs
Expiration Date
x Signature of SuPervising
Name .s c Su".'...
Permits are non-transferable and expire if work is
""i ""tr.a
within 180 days of issuance or if work is
B.
F
iriffiut p}J*ffi,ffilC
City
Installation, Alteration or Relocation
200 AmPs or less $ 50'00
201 AmPs to 400 AmPs $ 69'00
401 AmPs to 600 AmPs $100'00
Address
rh
CiWS ?ring6e\J Phone ?1U -5958
OWNER INSTALLATION
The installation is being made on properry I own which
is not intended for sale, lease or rent'
Ovners Signature:
I
Over 600 or 1000 Volts see "B" above.
D.
New Alteration or Extension Per Panel
One Ckcuit
Each Additional Circuit or with
Service or Feeder Permit
$ 43.00
$ 3.00
E
Pump or irrigation
Si grriOutline Lighting
Limited EnergY/Residential
Limited EnergY/Commercial
Minimum Electric Permit Inspection Fee is $'15'00 * Surcharges
s 50.00
$ s0.00
s 2s.00
s 45.00
4.3.&-)
q..{\
7% State Surcharge
10% Administrative Fee
TOTAL
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lnspection Request: 726'37 69 ffi"-
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Shared Drive(T:/Building Forms/Electrical Permit Application I 43'docIwLrwu* --
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