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Home My WebLink AboutPermit Electrical 2003-04-21Gity of Springfield Electrical Permit Attachment Status: Issued 225Fifth Street Springfield, Oregon 97477 541-726-3759 Phone 541-726-3676Fax 541-7 26-37 69 Inspection Line PERMIT NO.: ISSUED: APPLIED: EXPIRES: ELE2003-00109 4t2u2003 4t2u2003 10t21t2003 SITE ADDRESS: ASSESSOR'S PARCELNO.: PROJECT DESCRIPTION 246 l6THST 1703363104500 Reconnect only Springfield TYPE OF WORK: TYPE OF USE: Alteration Residential OWNER/APPLICANT: MCGINNIS TIMMY N & PENNY I\ 246 N l6TH SPRINGFIELD OP.97477 ELECTRICAL CONTRACTOR: TIM MCGINNIS 246 16TH ST SPRINGFIELD OR 97477 CCB # Expiration Date: 541-741-0364 Description + l0% Administrative Fee + 7o/o State Surcharge Service Reconnect Amount Paid s.00 3.s0 50.00 Date Paid 04t2U2003 04/21/2003 0412U2003 Receipt Number r20020000000000 l 03s I 20020000000000 I 035 r 20020000000000 r 03 s 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 Electric Service: Approval required prior By Signature, I state and agree, that I have information hereon is true and correct, the Ordinances of the City of certify that only contractors and to ensure that all required the approved set ofplans, 'o Owner or energizing service completed application and do hereby certify that all any and all work performed shall be done in accordance with Oregon pertaining to the work described herein. I further ORS 701.055 will be used on time, that each address is readable at all times during construction. \t Paee I of I arrtcffiE Date 41212003 l0:08:04AM City of Springfield Development Services Department Public Works Department Official Receipt 225 Fifth Street Springfield, Oregon 97 477 541-726-3759 Phone Receipt #: 120020000000000 1 035 Date: 0412112003 Line ltems: Job/Journal Number Descriotion Amount Paid ELE2003-00109 ELE2003-00109 ELE2003-00109 Service Recorurect + l0%o Administrative Fee + 7Yo State Surcharge Payments: 50.00 5.00 3.50 Line ltem Total:$s8.s0 Type ofPayment Paid By Received By Check Number Conlirm No lfow Received Amount Paid Check TIM MCGINNIS djb In Person 58.50 Total:$s8.s0 Page I ofl cReceipt.rpt Construction ContracL-. s Board 700 Summer St NE Suite 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-3784621 Web Address: www.ccb.state.or.us Statement: Information Notice to Property Owners About Gonstruction Responsibilities Note: Oregon Law, ORS 701.055(4) requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign thefollowing statement before a building permit can be issued. This statement is requiredfor residential building, electrical, mechanical and plumbing permits. Licensed architect and engineer applicants, exemptfrom licensing under ORS 701.010(7), need not submit this statement. This statement will be filed with the permit. Fill in the appropriate blanks and initial boxes I and2, and either box 3,A. or 38: F 1. I own, reside in, or will reside in the completed structure. 2. I understand that I must become licensed as a construction contractor if the structure is sold or offered for sale before or on completion. T 3A. My general contractor is (Name)(ccB #) I will instruct my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. OR F ,w 38. I will be my own general contractor. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to erty Owners about Construction Responsibilities on the reverse side of this form. 1- zl- 03 (Signature ofpermit applicant) (Date) (VThite copy to issuing agency permitfile, pink copy to applicant.) Permit #: Address: \*r an '7-. n -, Ec€ Zoo3" oo IOY Zq L* l6lL s1- Issued by:> 4 Date:q/z,fo= prop-own.doc 05/22/00 tu^€ WA utr{ az6 - 3-761 225 FIFTH STREET o SPRINGFIELD, OR97477 o PH:(541)726-3753 o FAX: (541)726-3689 ELECTRICAI Ciry Job Number 1. LACA TON OF INSTALI-ATION PFRMIT APPLICATION e{ezcrc -i ctclo'l l.t o frBtottow SCHEDLiLE Zoning A.Nerv Date 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 Each Additional Circuit or with Service or Feeder Permit 3. Y 2!a rtl. t1--t4 3T *o $ 106.00 $ 19.00 LEGAL DESCRIPTION uuit. lfos'36 3l o\ {c:c, JOB DESCRIPTION Sr<-e ur-ls'?+n-o^r,.*.-l City Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. I CONTRACTOR INSTALIATIAN ANI-Y Electrical Contractor Address Phone Supervisor License Number Expiration Date Constr. Contr Expiration of Supervising Electrician Owners Name Val /1)/ rUr<s t S $_s0.00 B. Services or Feeders - Installationo Alterations or Relocation: $ 63.00 $ 75.00 $125.00 $ 163.00 5.00 Reconnect Only C. 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsiVolts {$e $ s0.00 $ 69.00 4Q0'$ 100.00 see "B" above. New Alteration or Extension Per Panel One Circuit $ 43.00 D. E. 1$g Address A46 ,o. /b+^ST city %/P6EI-A- Ph.," 741-036 / OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Minimum Electric Permit Inspection SUBTOTAL OF ABOVE 4. 79/o State Surcharge 10% Administrative Fee TOTAL Limited 0s \S hs $ s0.00 $ 50.00 $ 2s.00 $ 45.00 Fee is $45.00 +Surcharges 3soE=- >o--:- J Inspection Request: 7 26-37 69 Shared Drive(T:)/Building Fonns/Elcctrical Pennit Application I -03.doc 57) -rt CITY OF OKE ON > (\-, Installation t t r.'r;,i-iri'ii l-i''l . .1. t,! ,i tl' -: