HomeMy WebLinkAboutPermit Electrical 1994-4-15
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SPRINCFIELD
~ 'tS,.........-""........- _...'...._..~. ....
zoning, and dOGS not require specflic land use
approval.
225 FIFTH STREET Zoninp LV ~J tyt' 'Dt..-
SPRING~IELD, OREGON 97~~ a.-I <::._qu
INSPECTION REQUEST: 726-:-37~ - fl3 M . Ci ty Job Number
OFFICB: 726-3759 'AuL :::.~" SIgnature .
, 3. COHPLETE FEE SCHEDULE BELOV
1.L9tCAW1J-OF I~TI~ /
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Permits are non-transferable and expire
if york is not started vithin 180 days
of issuance or ifvork is suspended for
180 days.
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2. CONTRACTOR INSTALLATION ONLY
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Electrical Contractor
ROSE CORP
Address
89976 DAY LANE
City
Phone---6..86.dl9D5
J:"JI(~J:"NJ:"
Supervisor License Number -15bBS
Expiration Date
10/1/95
,f
Constr Contr. Number
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54431 :--
C.
Expi'ration Date
q/~n/qs
Ovners
City
The installatioh is beirig made on
property I ovn vhich is not intended
fo~ sale, lease or rent.
Ovners Signature:
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DATE:
RECEIPT t:
RECEIVED BY:
y-/s..~y
/2 'g<"8
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New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Temporary Services or'Feeders
Installation, Alteration or Relocation
jJ
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
1000 sq. ft. or less
Each additional 500
sq. ft or portion
thereof ,
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
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
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
B. Services or Feeders
Installation, Alterations
or .Relocation:
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Signature pervising Electrician
.Ah .~/~
. '1!) [)flI1'T1 / D. Branch Circui ts
. .Oq (0.fYlhLr2 . III ;ttJew, Alteration or Extension Per Panel
/\L' (J -<<::1./ One Ci rcui t
uT{~Phone~ (\\.. J ._~ Each Addi donal
L ' Circuit or with Service
INSTALLATION or Feeder Permi t
Items
\
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volts
Cost
Sum
$ 85.00 72>-CS
$ 15.00
50
$ 40.00
$ 50.00
$ 60.00
$100.00
, $130.00
$300.00
$ 40.00
t
$ 40.00
$ 55.00
$ 80.00
see "8"
above
$ 35.00
$
2.00
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
loCS~
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/(dJ~7-5
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Job No. Q-O?'()3
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAM",X'\1\N)M _'00-l ')DQ.. . PHONE:~~D- m
ADDRESS:~CIdf r-iLtm,]LQQjD( STATE:~ZlPgg~
(nl'i/Jtcn (i)14
LOCATION OF PROPOSED BUlL JIN' rr.r~:\\f\ (\. V. ~.. ~
Street Address if Known: L" ~ l~ i)\l 6 -.....J\129)v
PI all Name: . \ l0"iG- Tax Lot Number: \ f1()~'~<::e()42[fJ
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back'>
A. Single Familv - Detached
\ Single Family home
NO OF UNITS l
Manufactured home not in a park (J:)
X $400 PER UNIT = $ 4lY) ,
B. Single Familv - Attached
NO OF UNITS
X $370 PER UNIT =
$
C. Multi-Familv Aoartment
NO OF UNITS
X $277 PER UNIT =
$
D. Manufadured Home Park
NO OF UNITS
X $280 PER UNIT =
$
WPRD SDC
$ 4W.(j)
$ [if
$ c!. fD ,00
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See SDC Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit)
t../ /~;)- / 9?-
Date
City of Springfield t'?c:?>~' ~;Z7 .4'-.5