HomeMy WebLinkAboutPermit Electrical 1995-1-10
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SPRINGFIELD
The following project as submitted has the folio
zoning, and does not require specific land use
225 FIFTH STREET epprove!, /J ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ,L.. Ole.--
INSPEctION REQUEST: 726-3769 zO/Onlon..... 'City Job Number 9t:;//$~
OFFICB: 726-3759 DMe I~ -~~
. ~~ COHPLETE FEE SCHEDULE BELOV
1. .-LOCATION ~~LAT:dltV:'oriZad Signature ' '
~S~0' ~~./fP>. A. Nev Residential-Single or
, .' Hulti-Family per dvelling unit.
, LEGAL DESCRIPTION ~ _ ~ Service Included:
17-1!>2-/9~o.- ,~dr/~ Items Cost: Sum
J~~ DESCRIPT~ 1000 sq.ft. or less --- $ 85.00 ~
-4/f{_'/1;:'?:?/"f"~.f~ ~...?'~-:'> . Each additional 500
t': sq. ft or portion
Permits are non-transferable and expire thereof ~ $ 15.00 ~
if york is not started vithin 180 days Each Hanuf'd Home or
of issuance or if york is suspended for Modular Dvelling
180 days. Service or Feeder $ 40.00
!
2. CONTRACTOR INSTALLATION ONLY
B. Services or Feeders
Installation, Alterations
or Relocation:
,
Electrical Contractor
ROSE CORP
Address
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnec t Only
89976 DAY LANE
City
Phone n8n-nqn~
~11r::~r~~
Supervisor License Number -15fiBS
Expiration Date
10/1/95
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C. Temporary Services or'Feeders
Installation, Alteration or Relocation
Constr Contr. Number
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5443i~'"
Expiration Date
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
q.L3!l/ q S
Signatu~ervising Electrician
" / /?..I!/ ~
v
Ovners Name
D.
Branch Circuits
$ 50.00
$ 60.00
$100,00
'$130,00
$300.00
$ 40,00
--s 40.00
$ 55.00
$ 80.00
volts see "B"
'7&>
above
Address
Nev, Alteration or Extension Per Panel
$ 35,00
City Phone
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
OWER INSTALLATION
The, installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
$ 2.00
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
E.
Ovners Signature:
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
DATE:_ I-/~-,??_
RECEIPT, t: t~.,..,
RECEIVED BY: ~~
-
not included)
tf-
$
$
$
$
/BS' -
" ::<> ~~
~~
/.,-, .SJt::;,
40.00
40,00
20,00
36,00
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o !!y}!I!o~~!~!!~
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Job No.
Cf4\Bf)S
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAME: ~ @is-\- ~~ ~ ~ ~rrJ_
ADDmS, ,q:J.. 7,,1'1 ,Ql.o 'SLt'\ ~
"_~'~~'~
Tax Lot Number: 11D1-\l\(Y) ?illPrO
LOCATION OF filROPOSED BUILDING SITE:
, Street Address if Known: (~'\-
Platt Name: \ 1\ \C\ )
, PHONE: 141. \ c:s 2>4
STATE: .Q{Z..zIP ~
1. DEVELOPMENT TYPE (Check appropriate dwelling(sl. SDC Calculations and dwelling type
definitions are on the back.!
A. Sinqle Familv - Detached
-.L Single Family home
NO OF UNITS J
B. Sin€,le Familv - Attached
NO OF UNITS
C. Multi.Familv Aoartment
NO OF UNITS
D. Manufactured Home Park
NO OF UNITS
WPRD SDC
Manufactured home not in a park c(J
$ .1f(). .,
X $400 PER UNIT _=
X $370 PER UNIT =
, $
X $277 PER UNIT =
$
X $280 PER UNIT =
$
$~
$ft
$ 400 pO
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Creditl
I I
Date