HomeMy WebLinkAboutPermit Electrical 2003-03-24Gity of Springfield
Electrical Permit Attachment
Status: missing from list
225 Fifth Street
Springfield, Oregon 97 477
541-126-37 59 Phone
541-726-3676Fax
541-7 26-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00085
3t2412003
SITE ADDRESS:
ASSESSORS PARCEL NO.:
PROJECT DESCRIPTION:
505 18TH ST
1703362400500
200 Amp Service
Springfield
TYPE OF WORK:
TYPE OF USE:
OWNERYAPPLICAIIT:
GALLIHER zuCHARD V & ROSAI
505 N I8TH ST
SPRINGFIELD OR97477
ELECTRIC AL CONTRACTOR:
CHRIS MILLERS ELECTRIC INC 54I-895-3660
33338 IDYLLWILD RD
CRESWELL OR 97426trBtt0t17 ExpirationDate:rzt2y2006
Description
+ lOoh Administrative Fee
+ 7Yo State Surcharge
Perm ServlFdr 200 amps or less
EDORISA
AY PERIOD.2200200000000000633
To Request an inryection call the 24 hour recording at726-37 69. All inspections reque$ed before 7:00 am. willbe made the same working day,
inspections requested after 7:00 a.m. will be made the following working day.
Required Inspections:
1 Rough Electric: Prior to Cover
2 Final Electric: When all electrical work is complete.
By Signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certiff that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield and the laws of the State of Oregon pertaining to the work described herein. I
further certiff that only contractors and employees who are in compliance with ORS 701.055 will be used on this project I
further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the
street, and that the approved set of plans, if applicable, will remain on the site at all times during construction.fu- k-v/{--ZE /44 d4-Z z-aa)
Owner or Contractors Signature Date
Amount Paid
6.30
4.41
63.00
*#?sHiI
IT SHALL EXPI
D UNDER THI
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225 FIFTH STREET . SPRINGFIELD, OR97477 o
E LECTRICAL P ERNI IT AP PLI CATI ON
Date
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LEGAL DESCRIPTION
o 5oo
JOB DESCRIPTION
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Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days.
)
Electrical
ci@ Phone tr- 3d /a
Supervisor LicenseNumber 4 3z>F 5
UF g.o /Expiration Date
Constr. Contr.Number A Z? 77
Expiration Date -z
Signature of Supervising Electrician
Owners Name
Address
Phone
Authorrzed sign ure
/z 200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
601 Amps to 1000 Amf3
o"#Q60ilH06iuuav
lzutoShddlUn$d SrHI ::
C.
D.
lYo State Surcharge
l0% Administrative Fee
TOTAL
A. New Residential - Single or Multi-Family 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
3.
$106.00
$ 19.00
$s0.00
COIrrfRACfOfi INS?XJ I-A'[ION OIYL!' B. Services or Fecders - lnstallation, Alterations or llclocation:
/ 1 ,.1'l)
s 63.00 G 5."
OM l
$ 7s.00
$12s.00
$163.00
$375.00
$ s0.00
Installation, Alteration or Relocation
200 Amps or less $ 50.00
201 Amps to 400 Amps $ 69.00
401 Amps to 600 Amps $100.00
Over 600 Amps or 1000 Volts see "B" above.
Branch Circuits
New Alteration or Extension Per Panel
One Circuit
Each Additional Circuit or with
Service or Feeder Permit
E.Miscellaneous (Service/feeder not included) -Each Installation
City
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
Owners Sigrrature
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
suBT'otrAL op- enove
$ s0.00
$ s0.00
$ 25.00
$ 45.00
4.6Db
1t
fi;*6'WMu Shared Drive(T:)/Building Forms/Electrical Permit Application l-03.doc
City Job Number
3G 2v
ti ra at ).a 4/
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$ 43.00
s 3.00