HomeMy WebLinkAboutPermit Electrical 2003-02-18City of Springfield
E lectrical Perm it Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
541,-726-367 6 Fax
541-7 26-37 69 Inspection Lin e
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00043
211812003
2fi4t2003
8/18/2003
SITE ADDRESS:
ASSESSOR'S PARCELNO.:
PROJECT DESCRIPTION
1544 sTH ST
1703263102200
Lighting Upgrade
Springfield
TYPE OF WORK:
TYPE OF USE:
Repair
Public
OWI\ERYAPPLICANT:
SCHOOL DISTRICT #I9
525 MILL ST
SPRINGFIELD OP.91477
EI,E CTRICAL CONTRACTOR:
BRIAN DAY ELECTRIC
298 ORCHARD VIEW TERRACE
MEDFORD 97504
CCB # 81081 Expiration Date: 0ll0l/2004
Description
+ l0%o Administrative Fee
+ 7%o State Surcharge
Add. Alter. Extend Circ
Add, Alter, Extend Circ Ea Add
Amount Paid
6. l0
4.27
43.00
18.00
Date Paid
02n8t2003
02n812003
0211812003
0211812003
Receint Number
2200200000000000487
2200200000000000487
2200200000000000487
2200200000000000487
ToReque$aninryectioncallttre24hourrecordingatT26-3769. AllrnspectionsrequestedbeforeT:00am.willbemadethesameworkingday,
inspections reque$ed after 7:00 a.m. will be made the following workrng day.
Required Inspections:
1 Rough Electric: Prior to Cover
2 Final Electric: 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 70f .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 Contractors Srgnature Date
lofl
WW*
2/r8/2003
10:19:l7AM
City of Springfield
Development Services Department
Public Works l)epartment
Official Receipt
225 Fifth Street
Springfield, Oregon 97 47 7
541-726-3759 Phone
Receipt #: 2200200000000000487
Date: 0211812003
Line ltems:
Job/JournaI Number Description Amount Paid
ELE2003-00043
ELE2003-00043
ELE2003-00043
ELE2003-00043
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ l}Yo Administrative Fee
+ 7Yo State Surcharge
Payments:
43.00
18.00
6.10
4.27
Line Item Total:s71.37
Type ofPayment Paid By Received By Check Number Confirm No How Received Amount Paid
Check BRIAN DAY ELECTRIC 1640 lkw In Person 71.37
Total:$71.37
Page I of I cReceipt.rpt
*F HNl3F,tSt-t}
225 FIFTH STREET ' SPRINGFIELD, OF.97477 o
E LE CT RT C AL P E P.lI{ IT AP P LI CATTON
City Job Number EIE }W> - OOOtt Date
I. LOCAT'IONOT'INS'I'ALIAT'ION
Y l\oFF 7T-
LEGAL DESCRIPTIONT,(
JOB DESCRIPTION,a
(2-<--
PH:(541)726-3'1 53 o F AX: (541)726-3689
The lollowing proiect as submitted has the following
zoning. and does not require specific land use
&- 15- o3 approval
Zoning
3. CO]VTPLEl'E )
Aurhonzed signature
A. Neu' Ilesidcntial - Single or Multi-I aruill' pcr drvelling unit.
Service Included
Permits are non-transferable and expire if work is
not started t'ithin 180 davs of issuance or if work is
Suspended for 180 days..:
c o NT r*4croR rNsryI raT I o N a NLY
Electrical Contractor BruMUL
;\,
SZi ,',*r t LL > h
Feeder
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Antps
601 Amps to 1000 Amps
Over 1000 Amps/Volts
Reconnect Only
Installation, Alteration or Relocation
Each Additional Circuit or with
Serrrice or Feeder Permit
Pump or irrigation
Sign/Outline Lighting
$ 106.00
$ 19.00
ss0.00
$ 63.00
$.75.00
$ I 25.00
$ 163.00
$375.00
$ 50.00
$ 3.00
$ 50.00
$ 50.00
Address 7?{oRatt&D / Arj 7Pq
Ciry 14 rpBc-l '*.*""Slg ?2? L
Supervisor License Number 3 ? {1s
Expiration Date /o- oLl
Consff. Contr. Number ? I a I
Expiration Date ct- oL
Signature of Supervising Elecnician
MENUEtrOH
lBO DAY PER
/-
ownersName -31)/-) SCrfu-ce \rsi-
200 Amps or less $ 50.00
201 Amps to 400 Amps S 69.00
llr .I-n ffit?&&l its,i""q [ooo uo,,, ,.. '*oou.-
.,*
06.'n,#JlHil cllt,,o
t,;,,
New Alteration or Extension Per Panel
oneCircuit I So:.oo Ll 3
iS
Nliscellaneous (Sen'iceifeeder uor included) -[:tclt InstallationE.Address
Cify
ll -.; r'l- N 7#'637s^Phone
OWNER INSTALLATION
The installation is being made on properly I own which
is not intended for sale, lease or rent.
Owners Signature:
Lirnited EnergyrResidential $ 25.00
Limited Energy/Commercial $ 45.00
Nlinimum Electric Permit Inspection Fee is $45.00 * Surcharges
4. STJBTOTAL OFABO\.E 6t
Yzl
L,to
7t\7
7o/o State Surcharge
10% Administrative Fee
TOTALInspection Request: 726-3769
-o.(-@J.
Shaled Drive(T:)/Building Fonns/Electrical Perrnit Application l-03.doc
?ro
-oq{
0090. you may obtain
calling theceffsr.500 sq. ft. or
Service or
Relocation;
or
C. Ternporarl' Services or Feeders