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HomeMy WebLinkAboutPermit Electrical 1993-3-8 . 1;-he following project as submitted ha", the following :Zoning, and does not require specific land usa epproval. 7) 225 FIFTH STREET '. L ~ ELECTRICAL PERMIT APPLICATION SPRINGFIELD, OREGON 97477 200lng_ INSPECTION REQUEST: 726:.,,3769:) - <J -tt3 OFFICE: 726-3759 Authorized Signeture 5' C 7- 3. 1. LOCATION OF INSTAIWATION :::l1~1) ".;)()2., '/K()A.A/laJ - . . LEGAL DESCRIPTION n ()2.,';).iltJ 04L./(YJ JOB DEScrq:P'i'I~ ~ II.uv-<-. cL - :JDO AMP Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days. I. 2. CONTRACTOR INSTALLATION ONLY B. Electrical Contractor.1..12A,; J;n dQ/~c{" Address_JD4:) ~/V1} 1!..()~L- Ci ty C(.) 1~/'Y\P Phone &:''ifi<.1 ldJo Supervisor Licen~e Number t1LJ~,~ Expiration Date 1'::1 Ja2., Constr Contr. Number :J.():f:JS?OC, Expiration Date l;:).jCj2., . Signature~is~n~ D. Owners Name~",)^"p, ()/Vl/JiA'-;' {I > ()/V\~ /55l Ci ty ~rf. Phone /44 .{)L/5t, 01lNER INSTALLATION Address The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: DATE~--------~~Tq-~ KJ><;t;.LPT. I: II_QQ RECEIVED BY: OP. City Job Number q 30 19-1 COI,rJ..t.." r"" SCHEDULE BELOV A. New Residential-Single or Multi-Family per dwelling unit. Service Included: Items Sum 1000 sq.ft. or less $ 85.00 Each addi tional 500 . sq. ft or portion thereof $ 15.00 Each Manuf'd Home or Modular Dwelling ~ or Feeder --L-- $ 40.00 ~ Services or Feeders Installation, Alterations or Relocation: 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 $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 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 $ 40.00 $ 55.00 $ 80.00 see "B" above Branch Circuits New, Alteration or Extension Per Panel One Circui t Each Additional Circuit or with Service or Feeder Permit $ 35.00 $ 2.00 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 J...JQ D() 5% State Surcharge d D() TOTAL ..!:::[;) _t'Yl . \ CITY OF.'IIIIlCFIELD SYSTCt-1S OEVELO.Jn WORKSHEET · (COllI1ERCIAL t, RESIDENTIAL) CIlAIIGE .;l/SO L~t\. NAlIE Olt COIWANY: J0_o.t::lJ"J\_,b.Q.r0.0~.<?& l'==-\;-- ~ow\ I::. p,.,,~ LOCATIOU: c,ljc. -ro\7E:. S:\:tJ2.~~!:lV.~ iv\0"-,11.-lC. t-l-brvlS I":> Mo\JtG~\~. DEVELOPMENT TYPE: [JUILDING SIZE: 1. STORM DRAIHAG( Il,tPERVIOUS SQ. rT. X SD.IBG rER SQ. Fr. (See Revcirse For Runoff Coefficients If Actual I~perv. Arc a LOT SIZe SQ. Ft. Is 0- Is Unknwn) 2_ SANITARY SEWER-CITY r:o. or rru's 1+ . x 538.55 rCR pru (See Reverse To Octenninc Total rrU'S) Is ?"?q I~ I _"J. le!1! L~J~Q.Bll\~iJ.Q; 1. no 0;' UU I T~ X Tf~ I I' !U\TE X CCST PER TR I P ,t::,jl_t ';' ~~C0 r:l ., - ............. -.....- ls 1/1..";-0.::..! x v ...~~~ r.l ,', J-'".... ~. ~, -_.--_..- ------.. ...... v X S383.Gl Odcmine Trip Rates) SU[JTOTAL '(ADD v (See Attacl;:nc~t C To ITEKS 1,2, & 3) S - , -; fv~ ..;;,. 4. AOI'!WISTRATIVE rEES_ 'U,'\SE CHARGE' (SUBTOTAL ABO\'E) X ~05 Is "7'OIj. I TOT/~.L-CII'{ ,-"",'"" .y,..:\.. 90 .~ €co - 5. SANITARY SEWER-I11-iI'\C '. 1l0. OF PFU'S .' I"+- x 513.25 PER PFU ,+ 510 l1\1HC ADMIN. FEE S /4 c; ~. .......- ,-" .......<.. .,~:':'~;~~'(iJse PFU Tot~.l From lte~2.Above) .."" - ..... '.' .-.....,....,.'-,..,...-. -..... NWI1~ 'CREDIT' IF' APPL-liislE .'(SEE' REVERSE) ': ..' '..' ,,:'~. . - -~. .~. .":" .~ .., K~-~Burdick SDC Coordinator : 0.{- /']-";;1 'V " . S TOTAL -MW~!C - SDC Is I ~ c; ~ J TOTAL SOCS qq {,. t/;!!.. . . .~."..' . . ," --:-. ....;-~ .~,. . ,...... . ~.~.. , ,- . :;.:.:-......-;1' :,. .' ..:./.: ~'''':;.;s. . . ... ;..' CITY OF.HIrlGF[ELD SYSTEl-1S OEVELOilliifNT CllAHGC OJ d \S"!I WORKSHEET · ,;lIS ~ '")'""'\ . (COll/1cncIAL t, RESIDENTIAL) 0 ~~ 0<-.:>1.:;1 rW1EOfZ COl'lI'AUY: J':JQ~T':'__hQ-'0.0~.~.&~f,:. ~oW\I::.PI\~ LOCATlOll :_c,Ij( i;;nr:- V'""J.JL\0]!:lY-;N MOP">".-t==:. U.~Mf..: I ":> M~lG"\ kl . DEVELOpr,\EHT TYPE: [JUILDING SIZE: LOT SIZE, .SQ. Ft. I. STORr.! DRAINAGE mrERVIOUS SQ. FT. X SD.IBG rER SQ. Fr. (See Reverse For Runoff Coefficients If Actual I~perv. Arca Is e- Is UnknO\.m) 2. SANITAlZY SniEfZ-CfTY NO. a:: rFV'S IL~ . X S38.55 PER PeU (See Reverse 1'0 Octeluine Total prU'S) Is ??"1"~ I ~.. JJ?r\rL~CD.:nJ3JJ.Q;I. rm 0:' UUITS X T~\IlI !V'\TE X COST PER TRIP t-,-rL: ____________4 ~ S:2S~CI I 1"- 0'. I )' /~';'-I \ v X ~3SS.Gl _____4'___.4 ..--' v X S3S3.Gl LJ~tCrr.Ilne Trip R.:.tc.::) SUBTOTAL' (ADD ITEl-\S 1,2, r, 3) S 4.f"",-;0 flv:'" - (See Attacl;:nc:1t C To 4. ADIHlHSTRATIVE FEES '[lASE CHARGE '(SUBTOTAL fillOVE) X ;05' I~ "7'OIj. I TOTt.L-CI1Y 50::, 90 -- €.C0 - S. SANITARY SEWER-H'..!IK ~ ,,'.110. OF PFU'S . ,., I ... Lf" . I ~o x S13.25 PER rFU .+ S!!ll-lWHC ADMIN. FEE S 4 c:; ;..-- .""." . . ~ . -....... -'-' ..,'-. .."'~ . ~lWHC CREDIT, IF APPLICABLE (SEE REVERSE) '. . '. '. '. :.;~.' :-. . - '. ~...__. - c.f /~'1 /f'V ..,,::.,...: ; .~:. . ..... (j Kip Burdick "'_ SDC Coordinator ';,. . S TOTAL-MW~lC SDC Is 1"7c)~ I TOTAL SDCS qq ~ e t. .: "'~:" .. -. - - - .,. ..; ~ \\~\ <6, ~q J,~!ortti.p '; :'~;j~:~{:~~.:}:',~-' - ... CITY OF.'IUtlGF[[LD SYSTG1S OEVELO~NT WORKSHEET · (COHI1ERC I AL t, RES IOENTlAL) CIIAIIGE 01 d- I SS-q ~\SO ""CUif\&\.... -t=I~O~ . NAll[Olt CO/WAN),: J:1,q~::L.;.._,lQ}'J1/.:~,~,~.&L'.:::.f,"- ~OW\I::.P",~ LOCATlOIl: SDC -ro1?~_e..'r-,.JL\0J!:lV~ M()f-';>II.-t2. U-orvlS I":> M.:>\JtG~\k.\. DEVELOpr.IEllT TYPE: []UI~DING SIZE: I . STOR/.j ORA IliAC C Il'\PERVIOUS SQ. FT. X SO.IBG PER SQ. Fr. (See Reverse FOI' Runoff Coefficients If Actual Imperv. t,rea LOT SIZE' .SQ. Ft. Is e- Is UnknO\;n) I ' Z, SANITARY SEWER-CITY 1:0. a:: rrv's 1+ . x $38.55 r[R PeU (See Reverse To Octeluinc Total prU'S) Is ??q I~ I 3. IBf~:r2'!.~.Q.l~TC\]J.Q;1. r:o 0:- UUITS X Tf~~;l !t!,TE X COST PErl TRIP i. __.~_'_~~~_.__ ~: SZES.Cl Is 1/'2-";,0'::"\ v 'f. $3~S.GI i, "'/' 'I -'---~------- -~~. v . y. S28S.Gl To Odcmine Trip Rate:) SUGTOTAL '(ADD ITmS 1,2,& 3) S - , 10'2 I;' (See Attach:nc",t C 4. ADllIIHSTRATIVE FEES '[]l\SE CHARGE' (SUBTOTAL ABOVE) X ;05 1$ "7'OIj. I TOT{:.L-CliY ::~0C. 90 r See ~ 5. SANITARY SEWER-H'..!I'\C. ',.' lID. OF PFU'S ",...f- x 513.25 PER rFU .+ S!!l1-lWHC ADMIN. FEE S 1"1 C, ~ ,": ......:.. , " "." '__A "" ........:,... ,', ;":,,:'(u:e rFU ,To~al_:ro~__.-!,~:,~2 .Ab,~,ve) ." ....< .._. ""0" . ,,''';:. . . c.f /~1 /1'2/ . s TOTAL-MlmC SDc,Is l"l c, ~ 1 TOTAL SDC ~ ~ e_ ~jWI1C CREDIT IF ArPLICABLE (SEE REVERSE) ~ n K:PBurdicK soc Coo'rdinator ..;:......:. ;"," ., t -:-.~..:--'.#..". ..... .~. ".,-:-, "~':., . ~:- :'~'~~:~~";~') . :': ,.. '. ...--:..:..... -. ..-....." . \.; i.J;1sB (1/13/l7 ..........,...' " .., CITY OF.n I nGFI [LO SYST[t-1S OEVELOf1W<7NT WORKSHEET (cO/mERC I AL t, RES IOENTlAL) CIlI\HGE ! NM1[' or~ COI.lI'ANY: J:~to.~::r..;.__lQH\0~_9J? L~f"_ . ~o WI I::. . PA~ LOCATlOll:--'spC. -ro17~_e..\-J.JL\0J!:lv~ M.r')p"I.-12- t-\-iJrvlt'-- I":> Mo';lI2.DII--1. DEVELOPl'lENT TYPE: []UILDING SIZE: .LOT SIZE' SQ. Ft. 1. STaRt.! ORA WAGE mrERVIOUS SQ. FT. . X SO.18G PER SQ. Fr. (See Reverse For Runoff Coefficients If Actual. Imperv. t,rea Is 0- Is UnknO\m) 7., SANIT^RY SEHf](-C!TY NO. OF rFU'S IL~ X $38.55 rER PFU (Sec Reverse To Octeminc Total prU'S) Is ??"1"~ I ~"i . ]J~LlL~J~Q.B.I!~IJ.rr 1. f10 Or: ur: ITS X TE I I' ;~)\TE X COST PER. TR I P ;, ___~_'.J~~____ ;: S32:.C1 [, .., '7 - 0'- I "' l--,,_';'-I v X $2SS.Gl i. .-.' v x S2S:S_Gl O~te~ine Trip Rates) SU[]TOTAL '(ADD ITEl-IS 1,2, i,3) S - , /(;;'7.. ,~ (See Attach~c[1t C To 4. ^1)IHHISTRATIVE FEES . . ' []1\SE CHARGE (SUBTOTAL fillOVE) X ;05 Is "7'OIj. I C,D TOT/~.L-CI1" 5::C, .r SCD ~ 5. SANITARY SEWER-MWI'\C -.," - .;. . :.' . '. .: .:, ~':'.':. ,._:>:,.<,i-(use PFU Total From Ite~2',A.bo~e) ..' . .~.' -: . N~I1C CRED-'IT- IF - ^~~~i"~~~E(SE~ REVERSE)' 110. OF PFU'S , ,...f- x S13.25 PER PFU .+ S!!) 1-I1-1HC mXIN. FEE s 1"1 t; ~ h'-"'" ,,'.' . .' ....,-.. ~~. """.'~. - . S .;:v . . "'.. ..". "" ,~ hK~-~~urdick '. SOC Coordinator - ..[- /1---111'2---- TOTAL -MWMC SOC. Is I q t3 ~ I TOTAL SDCS qq toe """,,,, ....:..... --. . --.# ~ .:- ..~.,: . .-" ..' ..''''":'' .-' '~~"':..'" " .' . ... 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