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Home My WebLink AboutPermit Electrical 2003-06-25Gity of Springfield Electrical Perm it Attachment Status: Issued 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-7 26-3769 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00158 6t2st2003 6t2512003 12t2st2003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 101 3OTH ST 1702310000703 Low voltage installation Springfield TYPE OF WORK: TYPE OF USE: Addition Commercial OWNER/APPLICANT: GOODWILL IND OF LANE COUN 855 SENECA RD EUGENE OR 97402 ELECTRICAL CONTRACTOR: ADVANCED TELECOM & SECURITY LWI-672.7721 2365 W HARVARD AVE ROSEBURG OR 97470 CCB # 124157 Expiration Date: 0310512007 Description + l}Yo Administrative Fee + 1Yo State Surcharse Low Voltage - Commercial Indus Amount Paid 4.50 3.15 45.00 Date Paid 06125/2003 0612st2003 06/2st2003 Receint Number l 20020000000000 l 633 I 20020000000000 I 633 l 20020000000000 I 63 3 To Request an inspection call the 24 hour recording at726-3769. 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 Low Voltage: Prior to cover. 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 required inspections are requested at the proper time, that each the approved set of plans, if appltcable, will remain on the site at all times during Owner or Contractors Signature tos address is readable from the street, and that construction. .,ng{r ^"rr1*t'S Page I of I *mf,3D T $ -\ 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department ELE2003-00158 ELE2003-00 I 58 + ljYo Administrative Fee + 7oh State Surcharge 4.50 3. l5 Item Total:$s2.6s Type of Payment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check ADVANCED TELECOM AND SECURITY djb In Person Payment Total: $52.65 $s2.65 Low Voltage - 225 FII''IH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o E LECTRICAL P ERMIT AP P LI CA:TI O N City Job Number Et[ZcnS -AO/5 tr Date Z'oi\e I. LOCAT'ION OT: INS'TEIIE?IO]V 3. tat 3ctt -t LEGAL DESCzuPTION A. New i7oZ3r oc>c>o703 a\ F'amily per dn'elling unit. 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 $r06.00 $ 19.00 $s0.00 B. Sen,ices or Feeders - Installation, Alterations or Relocation: )4 .IOB DESCRIPTION C LJ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. 2. COATTRACTOR TNSTALLATTON ONLY Electrical Address Phon" &;/-72:ZZ/ SupervisorLicenseNumber 77? /P * Expiration Date 1 O -ot-Zoa{ Constr. Contr. Nurnber I a 4 i 5'Z Expiration Date Signature of Supervising Elect ician V"/ d,o 6=-.(.-l I { 'f Luns Over 600 Amps or 1000 Volts see "B" above. D. Branrh Circuirs New Alteration or Extension Per Panel 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, Alteration or Relocation 200 Amps or less 20 I Arnps to 400 Arnps 40 I Amps to 600 Arnps One Circuit Each Additional Circuit or with \tService or Feeder os \$ $ 63.00 $ 7s.00 $ 12s.00 $ 163.00 $37s.00 $ 50.00 s s0.00 $ 69.00 $ 100.00 C Temporar.v Services or Feeders E. 43.00 3.00 -Each lnstallation Owners Name G Address ?Si S'e'atecA D\ City E&G Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signahrre: Energy/Comnrercial $ 45.00 q f Minimum Electric Permit Inspection Fee is $45.00 * Surcharges Ltf 3tt $ s0.00 $ 50.00 $ 25.00 4. SLTBTOTAL AF ABAVE 7oh Slate Surcharge l0% Administrative Fee TOTAL qso 57 6{- Inspection Request: 726-3769 Shaled Drive(T:),tsuilding Fonns/Eleclrical Pennit Applioation l -03.doc CITY OF OREGON