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Home My WebLink AboutPermit Electrical 2003-06-30City of Springfield Electrical Permit Attachment Status: Issued 225 Fifth Street Springfield, Oregon 91477 541-726-3759 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00163 6t30t2003 6t30t2003 12t30t2003 SITE ADDRESS: ASSESSOR'S PARCEL NO.: PROJECT DESCRIPTION: 123 1OTHST 1703354102400 Repair miscellaneous electrical problems TYPE Springfield OF WORK: TYPE OF USE: Repair Residential OWl[ER/APPLICANT: JONES FAMILY TRUST LLC PO BOX 9s SPRINGFIELD OR97477 ELECTRICAL CONTRACTOR: BEAR MOUNTAIN ELECTRIC LLC 54I-895-8833 PO BOX 912 CRESWELL OR 97426 CCB # 136298 Expiration Date: 08/06/2003 Description + l0% Administrative Fee + 7o/o State Surcharge Add. Alter. Extend Circ Minimum/Adiustment Electrical Amount Paid 4.50 3.l s 43.00 2.00 Date Paid 06130/2003 06/3012003 06130/2003 06130t2003 Receipt Number 2200200000000001 144 2200200000000001 144 2200200000000001 144 2200200000000001 144 Required Inspections: 1 Rough Electric: Prior to Cover 2 Final Electric: When all elechical worl h 0 I I U E:( rs comprete' TFrIS PtRiiliT SHALL EXPiRE lF THE !v0liK By Signature,I state and agree, that I have carefutty exami*ilThb$ifrFDt&{r4tificltlo$ Sffd'61&F$QJ*irv that all information hereon is true and correct, and I further certifygffiMfiflfiDflBl$fut$ p8folft0d,l&Otffi&one in accordance with the Ordinances of the City of Springfield and the laws of tnffi$qBtfuffipPRlEDing to the work described herein. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, and that the approved set of plans, if applicable, will remain on the site at all times during construction. To Request an inspection call the 24how recording at726-3769. All inspections requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following working day. Owner or Contractors Signature Date Page I of I ffif,s'B ra 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone City of Springfield Official Receipt Development Services Department Public Works Department 144 Date: ELE2003-00163 ELE2003-00163 ELE2003-00163 ELE2003-00163 Add, Alter, Extend Circ Minimum/Adj ustment Electrical + l0o/o Administrative Fee + 7o/o State Surcharge Item Total:$s2.6s 43.00 2.00 4.50 3.15 Type ofPayment Paid By Received By Batch Number Authorization Number How Received Amount Paid Check BEARMOUNTAINELECTRIC ddK In Person Payment Total: $52.65 $52.6s I, - 225 FIFTH STREET o SPRINGFIELD,OR97477 o pH:(541)EI,ECTRTCAL },ERIWIT APPLICATION Cily Job Number )bT U Date 726-3753 approval. Zoning 000 require specific submitted has the followino ,and use t LEGAL DESCzuPTION DES f,orf,,uol $ 43.00 $ 3.00 $ 50.00 $ 50.00 s 2s.00 T za ap Dat ttuth are non-transferable and expire if work is not started rvithin 180 days of issuance or if work is Suspended for 180 days. A. l\crv ttcsitlclrtial - Singlc or ,\lulti-I.'aluily, per clrrettifl' uy1'1. Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Serice or Feeder B. Services or Feeders - 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 t (r\ $s0.00 lnstallation, Alterations or Relclciltirin: $ 63.00 $ 75.00 $ 125.00 $ 163.00 $37s.00 $ s0.00 ", Electrical Address ICiry 1t5;t6 l/ phone o( Superwisor License Number Lt ltto 5 C. Temporarl' Services or Feeders Installation, Alteration or Relocation 200 Amps or less S 50.00 13 {z fi{}?ffi8:"P'to 400 Amps $ 69.00 rHi$F#mqts HMLfuffiP IRE IF TIiEWO'F1($ 100.00 Expiration Date Constr. Contr. Number Date S Owners Name Address City Phone OWNER INSTALLATION The installation is being made on propefty I own which is not intended for sale, lease or rent. Ownels Signature: or Extension Per One Circuit Each Additional Circuit or with Service or Feeder Permit Pump or irrigation Sign/Outline Lighting Limited Energy/Residential -o AU C /\l\&l$tl>oD E. &Iiscellaneous (Servicelfeeder not incluttred.l -Each Installarion Limited Energy/Commercial $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 * Surcharges 4. SL,firO?HI, oF ABOI/E iW 5D - 7o/o State Surcharge 10% Administrative Fee TOTAL n.s Sa usInspection Request: 726-3769 SharcvJ Drive(T:)/Building Forms/Electlical Permit Application I -03.doc 3. C{}MPLE"T'E BELOW /,Ll- $ 106.00 .$ r9.00