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Home My WebLink AboutPermit Electrical 1995-1-3 / SPRINGFIELD 225 FIFTH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. LOCATION OF INSTALLATION '5?2" r> #.8/n~.6 ~, \~~5~ON nro \~qs JOB DESCRIPTION A/~A'./ ~ <; J=K PermIts are non-transferable and expIre If work IS not started wIthIn 180 days of Issuance or If work IS suspended for 180 days 2. CONTRACTOR INSTALLATION ONLY Elec tncal Con trac tor A.I \1':.\.) f::1'Trl.e,'(', Address I d. .::::,w 3, ~ ~ Cl ty !f\cd~s Phone l.\l~'elt:sq SupervIsor LIcense Number I {)()(o ~ Expnatlon Date )l)-/-q::; Constr Contr Number {()'!,.llf-~ Expnatlon Date q-.l...J-Q5' SIgnature of SupervIsIng ElectrIcIan tl~/_~-r~A~~ Owners e~(t01 f11is Address ~q~) 32m Clty~ ~Jri > Phone ~ ~NSTALLATION The InstallatIon IS beIng made on property I own WhICh IS not Intended for sale, lease or rent Owners SIgnature: ~~~i::-:~-------l::~-~-~~-;;~-- RECEIVED B~il\l') ) -. ELECTRICAL PERMIT APPLICATION CIty Job Number G4ICM l p 3. COMPLETE FEE SCHEDULE BELOV A. New ResIdentIal-SIngle or MultI-FamIly per dwellIng unIt SerVIce Included Items Cost Sum 1000 sq ft or less I $ 85.00 Each addItIonal 500 sq. ft or portIon ~ thereof $ 15 00 Each Manuf'd Home or Modular DwellIng SerVIce or Feeder $ 40 00 B. SerVIces or Feeders InstallatIon, AlteratIons or Reloca tlon t6CS 3) 200 amps or less $ 50 00 201 amps to 400 amps $ 60 00 401 amps to 600 amps $100 00 601 amps to 1000 amps $130.00 Over 1000 amps/volts $300,00 Reconnect Only $ 40 00 C. Temporary SerVIces or Feeders InstallatIon, AlteratIon or RelocatIon 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Clrcul ts $ 40 00 $ 55.00 $ 80.00 see I1B" above New, AlteratIon or ExtenSIon Per Panel One Cl rcUl t Each AddItIonal CIrcuIt or WIth SerVIce or Feeder PermIt $ 35 00 $ 2.00 no t Included) MIscellaneous (SerVIce/feeder -Each InstallatIon Pump or IrrIgatIon SIgn/OutlIne LIghtIng LImIted Energy/Res LImIted Energy/Comm E. 5. SUBTOTAL OF ABOVE 5% State Surcharge 3% AdmInIstratIve Fee TOTAL $ $ $ $ H CQ.aJ J~ 40.00 40,00 20.00 36 00 B NO, 'f~/ ?4G CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) ATTACHMENT B1 NAME OR COMPANY JI"'-<,~ f.../. LOCATION ~ 3.2- 5" ~ 11 DEVELOPMENT TYPE SrI) BUILDING SIZE LOT SIZF SO Ft 1 STORM ORAINAGE I MPERV IOUS SO FT -2Jc.~ 2 SANTTARY SFWFR,CITY NO OF PFU'S / f' (See Reverse) 3 TRANSPORTATION X $0 209 PER SO FT ~~,~;; ---- X $43 26 PER PFU p~;-0 NO OF UNITS X TRIP RATE X COST PER TRIP X/,{) I X $436 19 U.4?SS~) X X X $436 19 X $436 19 $ $ SUBTOTAL (ADD ITEMS 1 2, & 3) $ 4 SANTTARY SFWFR,HWHr. NO, OF PFU'S / '6 x $17.19 PER PFU + $10 MWMC ADMIN FEE $ S/9,-/Z (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) $ >~ ~ 8 IlTIAI -HWHC SQC ~2-1i'o;t:_~{;) SUBTOTAl (ADD ITEMS 1. 2 ,3 & 4) $ / ., fT,?- 'T r; 5 AOMTNTSTATTVF FFFS BASE CHARGE (S~ ABOVE) X 05 ~~ ~ary Horn1g. P~ /' SDC Coord1nator 0"~?~~ Date /.,2-;Z:7- 7~ IlTIAI sac $ ,20 1"'6 "'1/ B2 SDC (NOTE For remodels, calculate only FIXTURE UNIT CALCULP TION TABLE: Number of New F,x! X Unit EqUIvalent = Fixture Units l'l.EI additional fIxtures) NUMBER OF NEW FIXTURES FIXTURE TYPE Bathtub Dnnkong Fountaon Floor Draon Interceptors For Grease/Oll/Solids/Etc Interceptors For Sand/Auto Wash/Etc Laundry Tub/Clotheswasher ., Clotheswasher . 3 Or More Mobile Home Park Trap (1 Per Trailer) Receptor For Refrogerator/Water Statlon/Etc Receptor For Commercial Sonk/Dlshwasher/Etc Shower, Songle Stall Shower, Gang Sonk: Bar, CommercIal, ReSidential Kitchen Unnal, Stall/Wall . Wash Bason/Lavatory, Songle TOilet, Pubhc InstallatIon TOilet. Pnvate Miscellaneous ,TJ.HI roR'.s ,$,//{K TOTAL FIXTURE UNITS UNIT FIXTURE EOUIVALENT UNITS 2 1 2 3 6 2 6 6 1 3 2 l/Head 2 2 1 6 4 ..1. = CREDIT CALCULATION TABLE Based on assessed value calculate credits separates I If Improvements occurred after annexation date on table, "" Year Annexed 1979 or before 1980 1981 1982 1983 . 1984 1985 Rate per $1 ,000 Assessed Value $346 338 332 321 306 292 273 Year Annexed 1985 1986 1987 1988 1989 1990 1991 1993 Rate per $1,000 Assessed Value $246 214 1 77 137 097 061 044 015 Credit for Parcel or land Only If Applicable Improvement (of after annexatIon date) X $ (Rate X Assessed Value) X $ (Rate X Assessed Value) = = CREDIT TOTAL = $ -=tiP LOCATION OF PROP~E~ WORK \. s.'A ~ S (\ 1\ 0 m rOO , 'Dxi ~ ASSESSORS M~ \L:l)'d-.O'<l1--1 TAX LOT nl9l1) LOT \ L1. BLOCK _ SUBDIVISION' J'\t\ ll~ f\ G.Qllln('E: OWNE~ _c)\'Z\ )- ,{\ Q1\ ?- f\t<.l '(\\\\,.\ [\Q J) \~(\0 .pHONE / \~ \d---\ L()lo ADDRE~ BC\~ ~~C) _~:J Ni \...'1\1\00 j-' CITY -":ll \ 1\ Lr'\ r\.U 0 ~ (\I , STATE llll 0 1)("<)1'\ \ ',\ ~ ~~ DESCRIBE WORK ~f\'r\^Q, ~()N\.lVL, \ ~oI\\c1Qf\0L NEW Y REMODEL t)ADDITION DEM ~ISH RESIDENTIAL PERMIT APPLICATION Inspections 726-3769 Office 7263759 SPflINGFIELD OTHER JOB NUMBER q~ I Cf4 ( rL 225 Fifth Streel Springfield, Oregon 97477 " ZIP Ol'\l~ CONTRACT~'~ NAM~ f ..I' ADDRESS GENERA"- q 't'Ll J.( \ QI\ f\ \"\ PLUMBING ~Jf(\Wi \ n~~OQ \ MECHANIC~ fu.L\clon rJ\:t-) ELECTRIC"" 0-..\ \ q A Y ~ Q]V{ '\\.J [' ) CONST CONTRACTOR' R \ f\q~ 5 \'\ ?{) A\'\C\S \ ()~'l~ Q~~Id~ ~o~.~\\ LD C\ /~,..?, l<irI)Q .- L\15.G\~ EXPIRES fj\~ q ~l\ f)\Q. L\4 - OFFICE USE - QUAD AREA ~~<( .- LAND USE \ \ \ \ FLOOD PLAIN . OF BLDGS \ . OF UNITS \ ZONING CODE -LD\:::- OCCY GROUP ~3-\;N\ CONSTR TYPE '00 . OF BDRMS ,!\ . OF STORIES \ HEAT SOURCE ~1-\ SECONDARY HEAT (25 WATER HEATER f .... RANGE f- SQUARE FOOTAGE \ \ 0 ct:> TO request an Inspection, you must call 7263769 This Is a 24 hour recording All Inspections requested before 700 a m will be made I,he same working day, Inspections requested after 70,0 a m will be made the following work day REQUIRED INSPECTIONS ~ Rough Mechanical - Prior to ~ cover D Temporary ElectrIc D Slto Inspection - To be mado after excavatIon, but prior to setting forms D Undorslab Plumbing/Electrical I Mechanical - PrIor to cover r\:7f Footing - After trenches are L..,.CS. excavated D Masonry - Steel locatlon, bond beams, groutl ng ~Found8tlon - After forms are erected but prior to concrete placemont D Undorground Plumbing - Prior to filling trench ~ Underlloor Plumbing/Mechanical - Prior to Insulation or decking r\:'A Post and Boam - PrIor to floor L..2:S.J Insulation or decking [g] Floor Insulation - Prior to deckIng rv1 Sanitary Sewer - Prior to filling ~ trench ~ Storm Sewor - Prior to filling trench f'Ql Waler Line - Prior to filling I..C::::ltrench ~ Rough Plumbing - Prior to cover [Q Rough ElectrIcal - Prior to LA.l cover ~ Electrical Servlco - Must be approved to obtain permanent electrical power D Fireplace - Prior to facing materials and framing Insp ~ Framing - Prior to cover C2I- Wail/Ceiling Insulation - Prior to cover lZlorywall - Prior to taping o Wood Stove - After Installation D Insert - Arter flreplaco approval and Installation of unit lZl Curbcut & Approach - After forms are erected but prior to placemont of concrete ~ Sidewalk & Driveway - After excavation Is completo, forms and sub base materIal In place D Fence - When completed D Slroot Trooc - When all required trees aro planted ~ Final Plumbing - When ell _ plumbing work Is complete I"Ll Final Electrical - When all ~ electrical work Is complete @FlnOI Mechanical - When all mechanIcal work Is complete C1l Final Building - When all L.Z:J-requlred InspectIons have been approved and building Is completed DOlhor MOBILE HOME INSPECTIONS D Blocking and Sot Up - When all blocking Is complete D Plumbing Connccllons - When home has been connected to water and sewer D Electrical Connection - When blocking, sel up, and plumbing Inspecllons have been approved and the home Is connected to the service panel D Final - Aller all required InspectIons are approved and porches, sklrtlng, decks, and ventlng have been Installed ') ,i 1 t ~ ~~ I Lot facos Lot Type ,- Lot sq Itg .x Interior I PL IN Lot coverage Corner Is Topography Panhandle ~ Iw Total height Cui-de sac IE BUILDING PERMIT ::,~ I \~T ~lcO X~Qa3 - ~ J4/~,,~ Garago Carport Total Value '11 [5'/0 ,~Lf~ to-11+ ~~ (A) <-)'){OlfIJ- J Building Permit Fee Slate Surcharge TOlal Fee SYSTEMS DEVELOPMENT CHARGE (SDC) 1";0917."'1/ (B) PLUMBING PERMIT ITEM FEE Fixtures Resldenllal Balh(s) N' c4- Sanitary Sewer FT Water FT Storm Sewer FT Mobile Home iWO.W Plumbing Permit W /(O(),OO J cx; I' + 8. (C) 172..~c) , - Stato Surcharge Total Charge MECHANICAL PERMIT Furnaco Exhaust Hood ~~ Vent Fan N' ~ . Wood Stovellnsert/ Fireplace Unit Dryer Vent (~ 00 Mechanical Permit l(o.SU 1000 f3~ &lID Issuance State Surcharge S6\ TOlal Permit (D) MISCELLANEOUS PERMITS Mobile Home Slate issuance State Surcharge Sidewalk ..J.D.... It Curbcul c5l.1..t2. fl Demolition rJ() SO 13. qa, S~ SurCh'R~ C)_ \ l'< ~ J.\ \'\0. t\. ~ l:\-l)q:J Total Miscellaneous Permits (E) TOTAL AMOUNT DUE (excluding electrlcald '). c:..O R0 (A, B, C, D, and E Combined) ,'y,:'l;j,1 . >A. ., Setbacks HSE GAR'ACC' is THE PROPOSED WORK IN THE _ HiSTORICAL DISTRICT, OR ON THE HISTORICAL REGISTER? If yes, this application must be slgnod and approved by the Historical Coordinator prior to permit Issuance APPROVED BUILDING VALUE, PLAN CHECK AND BUILDING PERMIT This permit Is granled on the express condlllon thai the said construcllon shall, In all respects, conform to the Ordinance adopted by the City of Springfield, Including the Development COde,regulallng the construction and'use of buildings, and may be suspended or revoked at any lime I upon violation of any provlslon3 of said ordlnancos Plen Check Fee . .,...... . ~ '" Date Paid \J ~ Receipt Numbe~ Y , Received By ~ ~~~,Llj:{ ') \~.Ci4 - ~ Dato Systems Developmenl Charge Is due on all undeveloped properlles within the City limits which are being Improved ADDITIONAL COMMENTS ~o:tt0 rx ~d020Q~ lA~\ \C),UU (~1-) , _cA.N\O.X.. \ q loO- J~ \ By signature, I slalo and agreo, that I have CClrofully examlnod the completed application and do hereby cartlly that all Information heroon Is true and correct. and I further certify that any and all work performed shall be dona In accordance with the Ordinances of Ihe Clly of Springfield, and the Laws of the State of , Oregon perlalnlng to the work described herein, and that NO OCCUPANCY will be made of any struclure without permissIon of the Building Safely Division I further certify that. only contractors and employees who are In compliance with ORS 701055 will be used on Ihls proJecl I further agreo to ensuro that all required Inspections afe requested at the proper lime, that each address Is readable from the streal, that the permit card Is located at the' fr~nt of the property, and the approvad set of plans V:i11 remain on the slle at ~" limes durIng construction ./'J Slgnatur/r'4~$_~ ~'"" Dalp / t1' VALIDATION /} RECEIPT N~ER _ Is Rg/ DATE PAID ~ h.3.45 AMOUNT RE;tf;D,j R '15 _ nb RECEIVED BY L{Jo....--J