HomeMy WebLinkAboutPermit Electrical 2003-04-18225FIFTH STREET
SPzuNGFIELD, OREGON 97+77
INSPECTION REQUEST :'7 26-31 69
OFFICE: 726-3'/59
I. LOCATIKlb ON OF INSTALLATIONS 13PL
LEGAL DESCRIPTIONtEoZaSZl c
JOB DESCRIPTION
EL RICAL PERMIT APPLICATION -;..
CitJ'Joh Nr*t,",'#€ZC'fi j' (i6 {'
gsz
3:.COMPLETE FEE SCFIEDULE BELOW
A. Neu' Rc.sirlentill-single or
Multi-Family per drvelling unit.
Ser-vice Includetl:
Items Cost
n
zed Signature
200 anrps or less
201 autps to 400 amPs
601 antps to I
$ 106.00
$ 50.00
$ 63.00
$ 75.00
il3#x,ffijfs'$fs'i3*,,
(-t1pilrova1
Permits are non-transferable and expire zoning
il u'ork is not started u'ithin 180 dai'9
of issuirnce or if u'ork is suspended for
180 da1's.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor fae
Address
sq ftor
-o or
Scn'ice or Feeder
B. Ser-vices or Feeders
Instirllation, Alterations or
Relocation:
{t-rJ.(<-
Ci
Supen'isor ,icense Nunber
Expiration D:rte
Orvners N
Over I
gr)
i.- Signaturc of Supcn'ising Electrician
amps or 1000 volts seeN
OWNER INSTALLATION
The installation is being Ittade on
property I ou'n *'hich is nol. intended
for sale. lease or rent.
B\'above
D. Brirnch Circuits
N
E. ]\IiT
Energl',ftes
Linrited Energv/Comnt
J. SUBTOTALOFABOVE
77o State Surchrrgc
87o Administratil'e Fce
Address -{b/ L-,/ Ll
Ne* Alteration or Extension Per Panel
B\OD
Citl'sfljil Phone
s50.00
$50.00
$25.00
I\Iinimunr Electric Permit Inspection Fec is s'l5'00 * srrrchirl'gcs
$15.00
to
J5'
56o
-a*
Orlncrs Signattrre
TOTAL >n
Sum
Constr Contr.
Expiration
v L
401 amps to 600
163.00 _
$375.00
$ s0.00
Each Additional Circuit or
$oil
v\ (:a.$43.00
Gity of Springfield
Electrica! Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00106
4n7t2003
4n7t2003
10t17t2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION
836 S 43RD ST
1802052108507
Service reconnect
Springfield
TYPE OF WORK:
TYPE OF USE:
Alteration
Residential
OWNER/APPLICANT:
COUCH BETTY L
4626BLUEBELLE WAY
SPRINGFIELD OR 97478
ELECTRICAL CONTRACTOR:
RALPH W BROWN 541-729-I5OO
1042 HORN LN
EUGENE OR 97404
CCB # 63137 Expiration Date: 02/15/2004
Description
+ l0% Administrative Fee
+ 7o/o State Surcharge
Service Reconnect
Amount Paid
5.00
3.s0
s0.00
Date Paid Receipt Number
04n7t2003 12002000000000010170411712003 1200200000000001017
. * - ^,
.0,a/,1,]{7 9i0in.' n t aw r e q u r re { trQffi Q@0000000 I 0 I 7
F\I
To Request an inspection call the 24 hour recording at made the same
working day, inspections requested after 7:00 a.m. will be
-0010 through oAR952-001-r^ naEl a5?-001
Required Inspections: bogo' You may obtain coples oI rrr' I ur'o v;'
'r Erectric Service: Approvar required prior to *,,,* ";iflle-#'ru*S:t;l'lllir!:."1fi::ffi-
By signature,I state and agree, that I have carefutty examined,o".mmiftt'AJinp"A#fhe3af;lereby 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 Springlield 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
the approved set of plans, if applicable, will remain on the site at all times during construction.
Owner or Conhactors Signature NoTtcE: Dut'
iflffiffiflffi*ilftH{$rinsr
Page I of I
ltrIIIEI[D
AL,
411712003
9:42:1OAM
City of Springfield
Development Services Department
Public Works Department
Official Receipt
225 Fiftla Street
Springfield, Oregon 97 477
541-726-3759 Phone
Receipt #: 120020000000000 I 0 I 7
Date: 0411712003
Line ltems:
Job/Journal Number Amount Paid
ELE2003-00106
ELE2003-00106
ELE2003-00106
+ l0o/o Administrative Fee
+ 7%o State Surcharge
Service Reconnect
Payments
5.00
3.50
50.00
Line Item Total:$58.50
Type of Payment Paid By Received By Check Number Confirm No How Received Amount Paid
Check BETTY COUCH djb In Person 58.50
Total:$58.50
-
Page I of I cRcceipt.rpt
I)escrintion
MEMORANDUM
DATE:
TO:
FROMr pervisN
July 15,2002
File
Lisa Hopper, Building Safety Su
Reference & Tax Lot Correction
Liz Miller
RE:
cc:
This memorandum is written to the file to change an incorrect entry made on job
number 850393 for the placement of a manufactured home located at 836 South
43'd Street, Springfield, Oregon. The correct reference and tax lot number for the
placement of the home should have been 1802052108507. The original record
could not be changed because the permit record is in historical data. This is
written for clarification and for information only.