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HomeMy WebLinkAboutPermit Electrical 1991-10-4 225 FrITH STREET SPRINGFIELD, OREGON 97477 INSPECTION REQUEST: 726-3769 OFFICE: 726-3759 1. ~~T~~~) \ ~~Q3~~5.~N ()~otoro ~O~ESN~r ~ V'\Jl/ Permits are non-transfe~le and expire if work is not started within 180 days of issuance or if work is suspended for .180 days. 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor Heritaae Elect Address 855 West 24th Avenue City Euaene Phone 344-1500 Supervisor License Number 9455 Expiration Date 10/1/ Constr Contr. Number 63137 Expiration Date 12/27/ Signature of Supervising Electrician .~ tJ.~ 9~5-[;, Owners Name Address City Phone OVNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: :~~n ~~-~~1i(-~~:;;;j--- RECEIVED BY: .7 JlS<..JJ.A.-.> I ~ ELECTRICAL PERMIT APPLICATION City Job Number Cl \()L4~ "'". * 3. COMPLETE FEE SCHEDULE BELOV Items Cost Sum 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home or Modular DveIling --& W Service or Feeder $ 40.00 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts D. Branch Circuits A. New Residential-Single or Multi-Family per dwelling Service Included: $ 50.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation B. 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 $ 40.00 $ 55.00 $ 80.00 see "Bn above New, Alteration or Extension Per Panel Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lightin~ Limited Energy/Res Limited Energy/Comm One Circuit Each Add it i onal Circuit or with Service or Feeder Permit E. 5. SUBTOTAL OF ABOVE 5% State Surcharge TOTAL $ 35.00 $ 2.00 not included) $ $ $ $ R{\CO 4~. '<(:A.~ 40.00 40.00 20.00 36.00 Metropolitan . Wastewater Managernent Commission . C.':::'5-:':" .,': .' ~~: =.: ~ f~'.'! :;- r ~';: :'.:. (:'.' :'": '!:' ~.:f,i ~.'~~'-fL;t:,f :'! :.'::l!:" ,",: ~:~:: E: ;!:': ";".-8:' ";',f': ~~. :{:':~:' ,:.~ C',':~ ~,"!: -.- ~;-:. ;':~': .~: ~ .: ::'::", C :,'.! "}~;~..';~~~~~::,'::i~.~:'.~.::. ~~:~:.:.~:~.~: ~~ t.~i:;. \':H::::',;-:~;i:..e l;)' :.~~'f:i:'.:,:.f ri:=iH A!'~D A SiF.EEIS - S~r,::-:SF:::LD CiTY r:;'.!..L - ~;:;:;;;\Gr:ELD. Cr:.EGC!J ~7':'77 l:LEr':-:C:,,~ {:C'::) 7":7...:::'i "'Wo. Add"", ~<~~c C~;;;JPA) R.f"'tf.b'" 1,)()c"YX) q.4. . Tax Lot Number:_Olo[oP'O O,,'ner: .()C~nQJ) p {\ . i_ /Pr1Ainxx-,~) . Address: \\C\. C\ ,{\ '\~>(\0 \: _ Phone Number: lo<?~J~\23 City: fA ')r~o JLL . State: (()J~ .D~BY\ Zip: q f\4('YZ...- ~ Residential Fee ($222.00) $r0Q~ ~ ___ Commercial Fee (new non-residential development/ remodel) Total fixture unit charge (see reverse of this form) $ SUBTOTAL $ Credit Due (see reverse of this form) <$ c9f) .45 > TOTAL HVHC CHARGE $ \q4,~ Date Received: 1D. 4.Q{ Receipt Number: <Q l~ . . Fi:\ture Uni t Calculatioll Tabl,,: ::uc,~"r cf r,e'" fi:.:tures l7.ultiplied by \!:li t equivalents. NOTE: For r"models, calculate only the ~ET additional fixt~res. Fixture Type 3a t h t \I b. . . . . . . . . . . . . . . . . , . . . . . . . . . . . . , . . . . Drinking fountain........ ................:. Floor drain..... .t....... .'.......~......... Interceptors for grea~e/otl/soli~s/etc.... Interceptors for sand/alito '.'~sh/€:c:.....:. Laundry tub/clothes \'asher.....:....,..... Clothes ~asher (3 or more)................ Mobile home park trap' (1 per ~.3.)........ Receptor for refrig/.ater statio~/:tc..... Receptor for Co~~er sink/dish~5~:!etc..... Shover, single stall.........,........,... Sho~er, gang (per head)., .............. '" Sink, bar, com~ercial... .................. Sink, commercial/industrial/etc........... Urnial, stall/.all...................,.... Vash basinllavatory, sir:gle, .............. Vater closet, public installatio;]......... Vater closet, private,.. .................. ~iscellaneous: .......... .......... .......... Total fixture units of Unit F xtures EquivalEnts Fixture L'ni t s 'i 2 1 2 3 6 .2 6 6 1 3 2 1 2 3 2 1 6- 4 Total Units: x $13.25 each = Total Charge: $ Credit Calculation Table: 3ased 0;] total ..alue of property at time of permit application. Year 'l..nJjejo:~d to the city 19104- 1979 1980 1981 1982 1983 19a~ 1985 1986 1987 19E8 1989 1990 Credit per $1,006 i!ssessed value $2.66 $2.64' $2.53 $2.41 $2.19 $2.04 $1.69 $1. 35 $1.15 $0.92 $0.59 $0.23 Credit x S to/5"LO Total Credit r:ate = S ;'.ssessed Val;..:e