HomeMy WebLinkAboutPermit Electrical 2003-2-18
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225 FIFTH STREET . SPRINGFIELD, OR 97477 · PH: (541) 726-3 7 53 '"tfMb\~MJ ~13J~-JM%ubmitted has the toll owing
ELECTRICAL PERAfIT APPLICATION zoning, and does not require specific land use
City Job Number ~L.€ In ~ -o~~4 Date I.. - /g - () 3approva', 'PL.O
. Zoning
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Authorized Signature
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LEGAL DESCRIPTION ',_,.' '",". .A. ,'i:;'WPS~~B,
AI I t:.1\l1 \Oi\i.Ule~ulL' .,",;?I,f".-",
:2. 3 S-.s- r'a L./l1V J;)A- fnllnw rules adoptedsw~lt@ Q~ftJ~9 t f rtt'
JOB DESCRIPTION Notification Center. T~8~tYI~$'~%#Y5e2_~01
, \ in OAR 952-001-001?!lJtR~~c1l~oIlal 5~~s&..fLm
7 c( a..c,--'---, '\~0090. You may obtalfjb61fi}jBl?ffiBMpe hI:;) J
,,~'II' the center. (Note: the telep o~e
Permits are non-transferable and expire it'iV~9Rl i~ 0 e~r,h. MGI1ilufaro"afw,-qrtje)15r
nLlmhorT0rthe r . IT.U'riTny ... . '
not started within 180 days of issuance or ['work IS . 1- , JB~~~~al.!i}:g Service or
Suspended for 180 days. Center IS . "eeder
Nfi,.'OE: Ov:r, 600 ~~J~\ [
Sianature of Supervising 1Je "an iHIS PERMIT BHl8gWa~~~.~
", UIEffHHS' 't
. -#.' ("\. AUTHORIZED 0 em~ffANB>ONE\!}~eRion Per Panel
/- ~ ~ COMMENCED B<tMfcuit, 1
. '{ . ANY 1 tlU DAY P acit'Xdditional Circuit or with /:.,
J " cUe ..L-l " ',..., -- Service or Feeder Permit 'J
Owners Name S{,,:::-i.J. ";> hvc...,L ,\..~)s. I
Address 52 ~. f'V'l ILL "j. r-
City S P I~ b Phone 7'it/ ,- (;37:;-
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Electrical Contractor 75 t< I m.J DA '1 E2.E' jlJ G
Address 7-crr o~cAt~ t) {EW 11;1'<,
r of(. S'! I I
City Y'1 r,Z:)t?~~ Phone 9" 'I 'iI.2.U> ft:7
Supervisor License Number' 3 '1 r'f 5
. , /
10- 0 'i
'i?/ocg I
, Expiration Date
Constr. Contr. Number
Expiration Date
O}- a"f
OWNER INSTALLATION
The installation is being made on property I own which
is not intended for sale, lease or rent.
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- - 0
Inspection Request: 726-3769
$106,00
$ 19,00
$50,00
B.
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
$ 63,00
$ 75,00
$125.00
$163,00
$375,00
$ 50,00
c.
Installation, Alteration or Relocation
200 Amps or less
201 Amps to 400 Amps
401 Amps to 600 Amps
$ 50,00
$ 69,00
$100,00
$ 43.00
ir-s
i g'
$ 3,00
E.
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Residential
Limited Energy/Commercial
$ 50,00
$ 50,00
$ 25,00
$ 45.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
4.
GI
L(2.7
~")i c;.
7/ '~7
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Dlive(T: )/Building Fonns/Elecllical Pennil Applicalion I-03.doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Line Items:
Job/Journal Number
ELE2003-00044
ELE2003-00044
ELE2003-00044
ELE2003-00044
Payments:
Type of Payment
Check
Paid By
Description
Add, Alter, Extend Circ
Receipt #: 2200200000000000490
Date: 02/18/2003
Add, Alter, Extend Circ Ea Add
+ 10% Administrative Fee
+ 7% State Surcharge
BRIAN DAY ELECTRIC
Received By
Check Number Confirm No
1640
Ikw
Page 1 of 1
.(
2/18/2003
10:28: 15AM '
City of Springfield
Development Services Depa~ tment
Public Works Department
Official Receipt
.
Amount Paid
43.00
18.00
6.10
4.27
Line Item Total:
$71.37
How Received
Amount Paid
In Person
71.37
$71.37
Payment Total:
cReceipt.rpt
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City of Springfield
Electrical Permit Attachment
Status: Issued
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
PERMIT NO.:
ISSUED:
APPLIED:
EXPIRES:
ELE2003-00044
2/18/2003
2/14/2003
8/18/2003
SITE ADDRESS:
ASSESSOR'S PARCEL NO.:
2355 YOLANDA AVE
1703244402200
Springfield
TYPE OF WORK:
TYPE OF USE:
Repair
Public
PROJECT DESCRIPTION:
Lighting Upgrade
OWNER! APPLICANT:
SCHOOL DISTRICT #19
525 MILL ST
SPRINGFIELD OR 97477
ELECTRICAL CONTRACTOR:
BRIAN DAY ELECTRIC
298 ORCHARD VIEW TERRACE
MEDFORD 97504
CCB # 81081 Expiration Date: 01/01/2004
DescriDtion
Amount Paid
+ 10% Administrative Fee
+ 7% State Surcharge
Add. Alter. Extend Circ
Add. Alter. Extend Circ Ea Add
6.10
4.27
43.00
18.00
Date Paid
02/18/2003
02/18/2003
02/18/2003
02/18/2003
ReceiDt Number
2200200000000000490
2200200000000000490
2200200000000000490
2200200000000000490
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00 am. will be made the same working day,
inspections requested after 7:00 a,m. will be made the following working day.
Reouired Insoections:
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 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
1 of I