HomeMy WebLinkAboutPermit Electrical 2003-6-26
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.' 225 FIFTH STREET .-~. <O\~~;~"~0~~,\0 :iC,:' ,; { . E~CJ;L P?L~MIT APPLIC!'TIO!'
'.' .' SPRINGFIELD, OREG ~o '8>0"Hr~ ;n~" , . ,'kf,./-:,'-'7Ar-, ",'f"~'/J~/
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LEGAL DESCRIPTION\.. ( "" '7 C':; Service Included:
170(.3000 01 f'- Q Items Cost
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ffi~~3 D{j fJla. ReUpS ./If)J4t!EIVT/o /Jr;1f,('S- sq, ft or portion
"':;1' . Pemul!are non-transferable and expIre thereof
".. if work is not'started within 180 days Each Manufd Home or
of issuance or if work is suspended for Modular Dwelling
180 days, . ',' Service or Feeder
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$106,00
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$ 19,00
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2, CONTRACTOR INSTALLATION ONLY
$ 50,00
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%/< Electrical~c~w~acto~;~i' R. Brabham,
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$50,00
$50,00
$25.00
$-15,00
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4. SUBTOTAL OF ABOVE
7% State SUI'charge
/p..iJ"/o Administratiye Fee
Minimum Electric Permit InSJlection Fcc is S45,00 + Surchal'gcs
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53, ~2-
TOTAL
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Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
PROJECT DESCRIPTION:
OWNER/APPLICANT:
CHROME WORLD
3240 OLYMPIC ST
SPRINGFIELD OR 97478
Descrintlon
+ 10% Administrative Fee
+ 7% State Surcharge
Add, Alter, Extend Circ
Add. Alter. Extend Circ Ea Add
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City of Springfield
Electrical Permit Attachment
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00156
6123/2003
6/23/2003
12123/2003
3240 OLYMPIC ST
1702300001928
Springfield
TYPE OF WORK:
TYPE OF USE:
Addition
Commercial
Install 2 circuits
ELECTRICAL CONTRACTOR:
LR BRABHAM 541-747-6638
68 WEST Q STREET
SPRINGFIELD OR 97477 '
CCB # 8699 Expiration Date: 12/18/2004
Amount Paid
Date Paid
Recelnt Number
06/23/2003 1200200000000001612
06/23/2003 1200200000000001612
06/23/2003 ,'\Q~0020000000000 1612
06123/2003, \T ,~~ ~ ~@.00200000000001612
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To Request an inspection call the 24 hour recording at 726~~,,~. All il'~~~~\e~le\t'\Sd{C}9lo0 a.m, will be made the same
working day, inspections requested after 7:00 a.m. wi~ll$"h\lde~I~~eIl"<Otld\l.~~
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Reouired Insoections: \I.~Q~~'t.~~~ ?'t.~~
1 Rough Electric: Prior to Cover Co \I.~'t \ CO\)
2 Final Electric: When all electrical work is complete.
4.60
3,22
43,00
3,00
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 tbat
the approved set of plans, if applicable, will remain on the site at all times during construction. 'IJ""-' . r" ,
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Owner or Contractors Signature "v.I....... ,-\\'Date\\.'.....I. fl""'''; \, ,'\ ' \ '. ,',',..'. i'\.";
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Page I of I
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
ELE2003-00156
ELE2003-00156
ELE2003-00156
ELE2003-00156
Payments:
Type of Payment
Check
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Receipt #: 1200200000000001612
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
Paid By
LR BRABHAM INC
Received By
djb
Check Number
Batch Number Authorization Number
City of Springfield Official Receipt ~
Development Services Department
Public Works Department J
Date: 06/23/2003 3:02:29PM
Amount Paid
Item Total:
43.00
3.00
4,60
3.22
$53.82
How Received
Amount Paid
In Person
Payment Total:
$53,82
$53.82
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