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Home My WebLink AboutPermit Electrical 2003-04-17City of Springfield Electrical Perm it Attachment tol AR 952-001 regon DAVIE 35690 ZEPHYR WAY PLEASANT HILL OR 97455 lres to tCt tort' -001 ol the rules b PERMIT NO.: ISSUED: APPLIED: EXPIRES: Springfield TYPE OF WORK: TYPE OF USE: OR ELE2003-00107 4n7t2003 RK \S NO CR IC LLC ,541 -895-8833 Date: 08/06/2003 Descrintion + l0% Administrative Fee + 7o/o State Surcharge Temp Power 200 amps or less Amount Paid s.00 3.50 50.00 Date Paid 04/1712003 04n712003 04t17t2003 Receipt Number 2200200000000000756 2200200000000000756 2200200000000000756 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 Temporary Elechic: Approval required prior to Utility Company energizing pole. 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 of the of Springfield and the laws of the State of Oregon pertaining to the work described herein. I further only and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to that are requested at the proper time, that each address is readable from the street, and that the will remain on the site at all times during construction. or Signature Date Pase I of I ryl Status: missing from list 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line 4/17t2003, l:23:46PM City of Springfield Development Services Department Public Works Department Official Receipt 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Receipt #: 2200200000000000756 Date: 0411712003 Line Items: Job/Journal Number Description Amount Paid ELE2003-00107 ELE2003-00107 ELE2003-00107 Temp Power 200 amps or less + l0o/o Administrative Fee + 7oh State Surcharge Payments 50.00 5.00 3.50 Line Item Total:$s8.s0 Type of Payment Paid By Received By Check Number Confirm No How Received Amount Paid Check BEARMOUNTAINELECTRIC NJM 2816 In Person 58.50 Total:$58.s0 Page I of I cReceipt.rpt Gity of Springfield Electrical 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: ELE2003-00107 411712003 4/17t2003 10n7t2003 SITE ADDRESS: ASSESSOR'S PARCELNO.: PROJECT DESCRIPTION 308 S 4TH ST 1703353400400 Temp power (Fire damage) Springfield TYPE OF WORK: TYPE OF USE: Repair Residential OWNER/APPLICANT: DAVIE LAWRENCE E & AMY J 35690ZEPHYRWAY PLEASANT HILL OR 97455 ELECTRICAL CONTRACTOR: BEAR MOUNTAIN ELECTRIC LLC 541-895-8833 PO BOX 912 CRESWELL OR 97426 CCB # 136298 Expiration Date: 08/06/2003 Description + l0o/o Administrative Fee + lo/o State Surcharge Temp Power 200 amps or less Amount Paid 5.00 3.50 50.00 Date Paid 0411712003 0411712003 0411712003 Receipt Number 2200200000000000756 2200200000000000756 2200200000000000756 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 Temporary Electric: Approval required prior to Utility Company energizing pole. 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 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 Signature Date Pase I of I lSMt* 225 FIFTH STREET . SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX:l$Elprmb€Elplec! as submitted has the tollowing )onirig anO does not require speciftc land use E LE CT RI CAL P ERM IT AP P LI CATI ON ciry rob Number €)-63Co3 - U lo1 Dare 1. LACAT'ION OF INSTANI-AT'ION 6 5 Lt-. S r JOB Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. raw I Notification oAR952-001 0090 -2344\ Supervisor License Number Expiration Date /a.o I L/ Constr. Contr. Number approval. Zoning 3. COruPLETE F'Eg,LiLE BELO\IT Authortzed Signature A.New Residential - Single or Multi-Farnily per drvelling 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 $ 106.00 $ 19.00 $s0.00 B. Sen,ices or Feeders - Installation. Alterations or Relocation: 200 Amos or less 2or Amps HfiddfiEi,' 4ol Ampsldb&?{itfidl 601Amps ro 1000 ED 1BO OAY Pump or irrigation Sign/Outline Lighting Limited Energy/Residential $ 63.00 $ 7s.00 IT SHALL EXPIR $ 125.00 $ 163.00 $37s.00 $ 50.00 7 Over I PERIO Date S Electrician Owners Name Address Cify Phone INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: C. Temporary Services or Feeders Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps Over 600 Amps or 1000 Volts see "B" above. D. Branch Circuits New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit jj ao f--o $ s0.00 $ 69.00 $ 100.00 $ 43.00 $ 3.00 E. Miscellaneous (Serviceifeeder not included) -Each lnstallatiott $ 50.00 $ s0.00 $ 2s.00 Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. ST.]BTOTALOFABOVE 1oh State Surcharge l0% Administrative Fee TOTALInspection Request: 7 26-37 69 Shared Drive(T:)/Building Fonns/Electtical Pemrit Application l -03.doc OREGO}ICITY..OF \