HomeMy WebLinkAboutPermit Electrical 1997-12-30
I'
COMM ERCIALlI N DUSTRIAL'
PERMIT APPLICATION
-
JOB NUMBER
9'7/7~O
225 Fifth Street, Springfield, Oregon 97477
INSPECTION LINE: 726-3769
OFFICE: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
( '~-,--,. '-..,
TAX LOT: (;<:::2S-~O "
PHONE: _(.-ftJB)'?2-~'-'7:b3 0 I
'-...:;~,# ~/ n-r'1
CITY:
STATE:
ZIP:
ARCHITECT:
NAME
lV/A
ADDRESS
PHONE
~, "
CONTRACTOR'S NAME
ADDRESS
CO NST,
CONTRACTOR #
EXPIRES
PHONE
GENERAL'
PLUMBING:
MECHANICAL:
ELECTRICAL' '
I PLUMBING
I NO. FEE CHARGE
I Single Fixture'
I Relocated Bldg, I
(new fix. addtl)
I Water Service I
ft.
I S~nitary Sewer ft. I
I Storm Sewer I
ft.
I Backflow Device I
I I
, I
I I
I I
I I
I TOTAL PERMIT
MECHANICAL
Nn
1=1=1=
C".~
I
Furnace/burner & vent
<100,000 BTUs
Furnace/ burner & vent
> 100,000 BTUs
I
I
I
I
I
Floor furnace and vent
Suspended wall or floor
mounted unit heater
Appliance Vent
separate
Stationaryevap.
cooler
Vent Fan/Single
duct
Vent System apart
from AC or htg.
Mechanical exhaust
hood and duct
I
Permit Issuance
$10.00
TOTAL PERMIT
- OFFICE USE -
HANDICAP ACCESS:
FLOOD PLAIN:
QUAD AREA:
LAN D USF'
# OF BLDGS:
# OF UNITS:
ZONING: '
OCCY GROUP:
CONSTR. TYPE:
LIGHTING POWER BUDGET:
# OF STORIES:
HEAT SOURCF'
WATER HEATER:
SQ, FT,
$/SQ. FT,
VALUE
SQ. FTG MAIN'
x
SQ. FTG ACCESS
SQ. FTG OTHER
X
X
'-,
TOTAL VALU.E OF .PROJECT---.380 .trO
PLAN CHECK FEE
-A-
RCPT# '
DATF
BY
I BUILDING PERMIT
15% State '7C: ,,/e.
SurcharQe I .IT/T1
I MECHANICAL
15% State I
Su rcharqe
I PAVING I
/5. c-o
. /,2.0
I PLUMBING
15% State
, Surcharge
I FENCE
VALUE $
I SIDEWALK
I CURBCUT
I DEMOLITION
FT.
I -
. '/ SUBTOTAL
PERMITS
I SYSTEMS
DEVELOPMENT
FT,
-:
TOTAL PERMIT FEES
EXCLUDING ELECTRICAL
/ ~ ,';2-- 0
"
........ ._on.-. ....:1 ro. .rJ- -. --- - .--.. .".- .0.- -.",... _. --'---'.'-(J
zonin~L and doss not require spESciiic i".":~~,-,~,,;}
approval. '
225 FIFTH STREET Zonina C G
SPRINGFIELD, OREGON 97!4Jl I:J '-:<ll--41J' '
INSPECTION REQUEST: 72o--S7~' Ci ty Job NUmber
OFFICE: 726-3759 Authorized Signature rn ~_ '
.' '. ~:~OHPLETE FEE SCHEDULE BELOV
1. LOCATION OF INSTALLATION a ~ ~ ~__ "
64/ W C/'L.i...)T~rJ; kt....- ~ ~ 'tt~ l~ Residential-Single or
, r'~ ~ ~ ~niti-FamilY per dw.elling uni t.
LEGAL DESCRIPTION. ~ ~ ~ ~rvice Included:
JID ~ ~_:27 4.::s b SY(j():~ ~ <:>e: ~ .
:4- Q ~ y~
JOB DESCRIPTION /~ ~ <t'h~~q. ft. or less
1-., e.l fl Lu. 17'-, t ~ Ea~I~ddi tional 500
-<? ~ ~~+ or portion
Permits are non-transferable and expire . ~ ~
if work is not started within 180 days ~~~f'd Home or
of issuance or if. work is suspen-ded for ~~~welling
180 days. Se~i~! ~ Feeder
:,~,~.,~
B. Services~r Feeders
Installation, Alterations
or Relocation:
2.
CONTRACTOR INSTALLATION ONLY
Elec trical Con t rac tor 1i1At:.~F_E'I-G-c-'i"fCAc .
Add res s ...L?I") /...ADA) (lJl f?
Cit~:t:~~..-:~ Phone~_?Jf\M-
Supervisor License Number JDCf7,8
Expiration Date /0 -J -9~
Constr Contr~ Number
90 zoo
Expira tion Da te
.3 -1,- 91\
Signature of Supervising Electrician
J-!~ ~~'>~
;vners Name (jJii,t,'''-'{1e#' ~ D.
Address ':pC). Pdo-r (3 2- r::/ '
Ci ty &v (L ~--.-(lJ.+--Phone
I
OVNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners' Signature:
---------------------------------------
DATE: Ia. - 36 - <=1,
RECEIPT:jj:: ~'6~(PS
RECEIVED BX: c:>\\tn _ )
ELECTRICAL PERMIT APPLICATION
Q7ll70
Items
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
200 amps. or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
'R:econnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C. Tempo~ary Services oi Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Oveir 600 amps or 1000 vol ts
$ 40.00
$ 55.00
$ 80.00
see "B", above
Branch .Circui ts
New, Alteration or Extension Per Panel
One Circui t / $ 35.00 3,i). oU
Each Additional
Circuit or with Service
or Feeder Permi t ,) $ 2.00 / C). 00
E. . Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res . $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE -11\. oD.
5% State Surcharge 2. .2,5
3% Administrative Fee J .:~~
TOTAL L/5r .&;0
LkE ~At---ry' )r 2-
CI-? ..-20