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HomeMy WebLinkAboutPermit Signage 1992-10-22];i GN PERIVIIT APPLICA'TI OI'J .r25 Fif rh Street Sprirrglield, OR 97 47 7 SII'I- ADDHESS ASSESSORS MAP: OWNEII: ADDRESS CI Y BUSINESS N E, Flntvl !;PftINC;FIELfI JOB NUMBET] ]'AX LoT lnspection Line: 726-3769 OIfir:e: 726-3759 ZIP: PIIONE: STATI: t)R N OF PROPOSiED SIGN(Sl: (please clreck and complete all approl)riate information) -_-= Freestarrding __ Projecting *-_ Billboard __- Roof _ l\4arquee Sirrgle Facr: -_--. Doulrle Face _ ___ Other 4tcre Footage: _ Vertir;al Dirnension oI srqn r)r r:nclosure: _ Total l{eight abrrve Grade: Horizontal \,Vidth rif sign or cnclosure Dirnension lrom Grade to b(.)tlonl of Sign Enclosure: Eler;trical lnstallation: __= Yr:s (lf yr:s additional elt:ctrical perrlit ( No 'ALUEifEquirr:d) OF SIGN: 'b m \ N,4ilte rial Sigrr is constrrlcted !)f : Lis;l ALL t:xisti (a) '[ype srgnai)e €rnd attach a photograph of each sign 1(J (bl Typrr Sq. Ftg. _ Sq. Ftg.(r;) Type Fro (rl) Type .-- CONI RACI'OR/IN ADDRESS CITY:STA PHONE ZIP: A, r^o..,o*CONS TRUCTION C CITY BUSINESS LICENSE NUIVIBEIl REG I STf INTION IiIUITIBEII: ES: OFFICE USE Sigrr District Zoning rl Use -__- Ccrdr.l Section:, _-_- Aplrroved By Ouad Area lller:l rir:al prior to tlnerlyizing electrical installation Sirrn Permit Fee:- * DATI::z)o-" llt Ollltt[:D INSPECTIOIiIS: -. _-*._ Site to l;e rnade prior to sign placement Footin,l prior to plaoenrcnt of concrete Atlachmcrrt rrller las;terrr)rs are installed/prior to cover Y/ 0,,, cfnpletion of sign ifistallation Atlditional Comrlents rrnd/or Conditir)nil By sigrrature, lstate arrd agree, that ltrave carefully examined the complct(:d application and do hereby certify that all information hereirr rs true artd correct, anrl lfurther certify that any and all work performed strall be dorre in accordance with tlre Ordinances of the City of Springfield, and the Laws oI the State of Oregon pertaining to the work described herein. llurther certify that only conlractors an(l enrployees who are in contpliance with ORS 701.055 will tre used on this proiect. I lurther agree to ensure that all required inspections are reqUested at the proper time, that project address is readable lrom the street, that thc pt:rmit card is I at tlre fro ol the property, and tho approved set of plirns will remairr on the site at all timcs durirrg the installation ol thr:tt Signature Validatron: Da re Amorrnt Received: -/ -?5 Datt: Paid: Receipt Nurnbtrr A,a ltc:ctrived By 5> ll 1m ?t lc$flnO , // SICN I'ERMIT APPLICATION The application on the reverse side needs to be completed entirely. lf you are the sign contractor/installer, or if you are hiring a contractor, you need to make sure that botn ine city of Springf ield Business l-icerrse Number and the Registration Number from the State of Oregon Construction Contractors Board are listed on the application alorrg with the expiration date of each. lf the sign you are proposing to install is illuminatcd, an elcctrical permit application alt;o needs to be completed and signed by eitlrer a supervising eleclrician, limited sign electrical contractor, or if you are the business owner who also owns tlre building in which you are occupying, and you will be performing the electrical irrstallation yourself, you may sign the electrical aPPlication. lf there are existing wall and/or lreestanding signs, a photograph(sl of eaclr oxistirrg sign needs to be attached to tlre application. The size of each existing sign also needs to be listed on the applicatiorr' PLANS To submit for a sign permit, you need to prepare two complete sets of drawings showing all dimensions, total height' and a plot plan indicating where ihe proposed,sign will be located. lf you are installing a freestanding sigrr which exceeds 20 Ieet in total height. the footing detail npeds to be prepared and stamped by a registered engineer or architect' After the plan review process is completed, and. if your signisl is approved, one set ol plans will br: returned to you' The approved set of drawit-rgs need to be at the site when an inspection is requested lor the inspectors reference' INSPEC I-IONS Depending on your sign(sl, you may be required to requcst one or all of the following irrspections durin(l the installation of your sign Site:To be requested aftcr indicating on the lot where thc proposed sign will lle located but prior to any work being performed for the install;tion of the sign. This inspection is requiled if there is a question on the location of the ProPosed sign. lf there will be Footing Alter all required inspections are conducted and approved and the sign irrstallation is r:ornplete The inspections that are required for your sign installation will be indicated on the application during the plan review process. Failure to request Aruy of the require*d inspections could result in sign removal in order to inspect the sign at the required intervals of work. To request an inspcction, phone 726-3769. This is a 24 lrour recording. On the recordinil you will rreed to leave your City Designated Job Number, location of where the sion is being irrstalled, the type of inspection you are rerquesting, and when yo, iritt be ready ior the inspection. All inspections called in to the recorder prior to 7:00 a'm. will be rnade the same working day. all inspections phoned in after 7:00 a.m. will bemade the following work day' lf you have any questions regarding the allplication, required plans or inspections, please feel Iree to phorle the Building SaIety Division at 726-3759. City of Springlicld Building Safety Division 225 Fifth Strcet Sprirrgfield, OR 97477 To be requested after excavatior-t ui\O tf,e forms are installed, but prior to pourin0 corlcletc' electrical conduit placed in the footing, it rnust also be in place prior to roquesting this ins To be requested when all fasteners are installcd but prior to cover' To be requested aftcr the electricirl connection to the sign is made, but prior to encrgizing pection Attachment: Electrical: Final: i' C'TY OF slrtilN(;FtELE) r.t9e ft BLBCTRICAL PERHTTCw_\City Job Number hns the 2ie 225 T'IFTE STRBET SPRTNGFTEIJ, oREGON 97477 INSPECTION RBQIIESTT 726-3769 OPPICE: 726-3759 1 APPLICATIONq{Dm3 Permlts are non-transferable and expireif work is not started vithin 180 daysof issuance or if work is suspended for 180 days. 2. CONTRACTOR INSTALI,ATION ONLY Electrical Contractor Address Ci ty Supervisor cense Ntimber Expiration Date \c\5 Constr Contr. Number 3bg2 Expiration Date ture of sing Blectrician ress BELOV A. l'Iew Residential-Single or l,lulti-Family per dvelling unit. Service Included: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Manuf'd Home or Modular Dvelling Service or Feeder $ Bs.oo $ 40.00 Services or Feeders Installation, Alterations or Reloeation: 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 c Temporary Services or Feeders Installation, Alteration or Relocation D. Branch Circuits Nev, Alteration or Bxtension Per Pane1 200 amps or less $ 40.00 201 amps to 400 amps _ $ 55.00 Over 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see ilBl above Sum , JOB DESCN PTION.+ \!}_\0q,--.Ir-\ B R $ s0.00 $ 60.00 $100.00 $130.00 $300.00 $ 40.00 Ci ty Pho OITNER ON The installatlon is being made on property I own vhich is not intended for sale, lease or rent. 0vners Signature: DATE: E. l'liscellaneous (Service/feeder not included) -Each installation Prrmp or irrigation Sign/Outtine Lighting- Limited Energy/Res Limited Energy/Comm 5. STIBTOTAL OT ABOVB 5Z State Surcharge TOTAL ""lLb_\\Lg One Ci.rcui t \ Each Additional Circuit or vith Service^ or Feeder Permit tn $ 3s.00 s 2.00 00 00 00 00 =i5 -L^a $ $ $ $ 40. 40. 20. 36. d) n 0 RECEIVED BY: $ 1s.00 ,n"."_4\clCLq/ \\Dq5 COM M ERCIAL/IN DUSTRIAL PERMIT APPLICATION 225 Fitlh Street, Springfield, Oregon 97477 SPRI}IGFIELO JOB NUMBER INSPECTION LINE: 726-3769 OFFICE: 726-3759 LOCATION OF PROPOSED WORK:/ll{ llohank BlvJ ASSESSOBS MAP:1703A633 TAX LOT:oqqo0 PHON E: OR ZIP: Ca STATE:( 72G -//??OWNER: ADDRESS: CITY: I/-VALUE:t.400e'DEMOLISH OTHEFI DESCRIPTION OF WORK: NEW REMODEL ADDITION NAME ADDRESS PHONE ADDRESS EXPI RES PHON E GENERAL: CONTRACTOR'S NAME AFICHITECT PLUM BI N G: MECHANICAL: ELECTRICAL: CONST. CONTRACTOR # PLUMBING NO FEE CHARGE Single Fixture Relocated Bldg. (new fix. addtl) Water Service ft Sanitary Sewer ft Storm Sewer ft Backf low Device TOTAL PERMIT MECHANICAL NO trFF NHA EIGtr Furnace/burner & vent < 100,000 BTUs Furnace/burner & vent >100,000 BTUs Floor furnace and vent Suspended wall or f loor mounted unit heater Appliance Vent separate Stationary evap. cooler Vent Fan/Single duct Vent f rom System apart AC or htg. Mechanical exhaust hood and duct Permit lssuance $10.00 TOTAL PERMIT A a) OFFICE USE53DLAND USE: ZONING:* OF UNITS: LIGHTING POWER BUDGET: WATER HEATER HANDICAP ACCESS FLOOD PLAIN OCCY GROUP: d OF STORIES QUAD ABEA: * OF BLDGS: CONSTR. TYPE: HEAT SOURCE: SO. FT.$/so. FT.VALUE TOTAL VALUE OF PROJ X X X SO. FTG MAIN SQ. FTG ACCESS SQ. FTG OTHEFI RCPT#PLAN CHECK FEE DATE BUILDING PEBMIT J$ 5D PLUMBI NG DEMOLITION 5% State Su rcharo e lt8,5% State Surcharoe MECHANICAL FENCE VALUE $ 5% State Su rch aro e SIDEWALK FT. SUBTOTAL PE RM ITS PAVING CURBCUT FT. SYSTEMS DEVELOPMENT J4 \.osTOTAL PERMIT FEES EXCLUDING ELECTRICAL @ BY V REOUIRED INSPECTIONS J It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call 726-3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready for inspection. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:O0 a.m. will be made the following work day. SITE INSPECTION: To be ROUGH PLUMBING, PAVING: After gravel is in made after excavation, but ELECTRICAL & place but prior to placing prior to setup of forms. MECHANICAL: No work is to asphalt or concrete. be covered until these UNDERSLAB pLUMBING, inspections have been made SpECIAL INSpECTIONS: ln accordance ELECTRICAL & and approved' Section 306 0f the State Specialty Code MECHANICAL: To be made a special inspector shall be employed before any work is covered. ATTIC DRAFT STOPS & by the Owner/ Contractor duringCURTAIN WALLS construction of the following w6rk. A FOOTTNGS & FOUNDATTONS: copy of the special testing reports shall To be made after trenches are FIREPLACE: Prior to placing be furnished io the Building Division. excavated and forms are facing materials and before erected, ail steel in place, but framing inspection' srRucruRAL CoNCRETE: ln prior to placing concrete. FRAMING: To be made after excess of 2500 P.S.l. (306 a.1) coNcRETE SLAB: To be the roof' all framing' fire made arter ar insrab buirding 3l::5::.":fl 3,'ifftJ,';;:r" iln:'.Tyf3^t,YitT',rrr, ,service equipment, conduit, and vents are'complete andpiping, accessories and other incirarv equipment items are ffi'fl'":lf;t"jffi,1,JJ;[3::: Bl?,lf],ffi]?T*,?,t,.T}i".in place but before any tighte-ning operations. (306concrete is placed. INSULATTON & VApOR a.6) BARRIER: To be made after all UNDERGROUND: Plumbing, insulation and required vapor SpRAyED ONelectrical, gas, sanitary sewer, barriers are in place but FIREpROOFING: U.B.C.Storm sewer, water and before any lath or gypsum Standards 43-8.drainage lines. To be made board interior wall covering is lrtJ::;:":"r.rins or fillins applied. spEctAL GRAD.NG, uNoERFLooR: p,umbins [l::,fl'"="'f;m']fl[H]"' iffiiJEiil#ll',5J:'i],"1 electrical, mechanical. To be according to plans. chapter 29) made prior to installation of floor insulation, decking or LATH ANOTOR GYPSUM GLU'LAM BEAMS: lnspection floor sheathing. BOARD: To be made after all Certificate by an approved lathing and gypsum board, agency, furnished to the city's POST & BEAM: To be made interiol and exierior, is in Building Division before prior to installatlon of floor place but before any beams are placed' (2501 U'B.c' insulation, decking or floor plastering is applied or before STDS' 25'10'11)' sheathing. - Sypsum board joints and fasteners are taped and STRUCTURAL MASONRY: (306 FLooR TNSULATToN & finished' a'7) VAPOR BARRIERS: To be made prior to installation of decking or floor sheathing. MASONRY: Steel location, bond beams grouting or verticals in accordance with UBC 2415. ROOF SHEATHING AND NAILING: Prior to installing any roof covering. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete and form work and sub-base material in. place. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. *ln addition to the inspec- tions specified, the Building Official may make or require other inspections of any construction work to ensure compliance with the Building, City or Development Code. FINAL PLUMBING FINAL ELECTRICAL FINAL MECHANICAL FINAL FIRE DEPARTMENT SITE PLAN REVIEW BOARD: Must be requested 2 days in advanceof the date you wish inspection. All project conditions such as landscaping, parking Iot stri ping, etc. must be completed before requesting this i nspection. FINAL BUILDING: Requested after the final plumbing, etectrical, mechanical and Fire Department inspections are made and approved. No occupancy of the premises can be made until aCertificate of Occupancy has been issued by the Building Divisionand posted on the premises. ADDITIONAL COMMENTS: -PLANS REVIEWED BY DATE By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein is true and correct, and I f urther certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUpANCywill be made of any structure without permission of the Building Safety Division. I further certify that only contractors and employeeswho are in compliance with ORS 701.055 will be used on this project. Signature Date e il rtu her toree NS thure al Uag red NS Son reare ested atreqpect he m ath roquproper addect re ISS abreadp frole thmstreehathecat,rd IS atocated he ro npermi he and aherty,prope et o an S m atprovedpplre n no h it aat ESm U nri ionUconSts -?E-?2_/ 6BVALIDATION ( AMOUNT RECEIVED RECEIPT #RECEIVED BY: DATE PAID ? 7i SartrtN(;rtELt) ab 1. ON JOB Permits are non-transfer e and re if vork is not started vithin 180 of issuance or if work is suspended for 180 days. 2. CONTRAC;TOR INSTALI.ATION ONLY Electrical Cont tor Addres 225 FIFTE STRBEf, SPRTNGPTELD, oRBGoN 97477 INSPECTION REQI ESTT 726-3769 0FFICE: 726-3759 ci Phone Supervisor License Number Expiration Date Constr Contr. Number Expiration Date Signa of rs Address PERfiIT APPLICATION City Job Number COHPI.^BTE FBB SCMDULE BBLOII A. Nev Resid€ntial-Single or MuIti-Family per dvelling unit. Service fncluded: I tems Cos t L000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home or Modular Dwelling Service or Feeder $ Bs.oo s 1s.00 $ 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_ 0ver 1000 amps/volts Reconneet 0nly C. Temporary Services or Feeders Installation, Alteration or Relocation .fu qs4 lrrl q Sum B $ s0.00 $ 60.00 $100. 00 $130.00 $300.00 $ 40.00 Ci ty OgNER ,TION The installation is being made on property I own which is not intended for sale, Iease or rent. Ovners Signature: DATE:. * D. Branch Circuits Nev, Alteration or Extension Per Panel One Ci rcui t S 35.00 Each Acldi t ional Circuit or vith Service or Feeder Permit $ 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation Sign/Outline Lightir Lirni ted Energy/Res Limited Energy/Comm SUBTOTAL OP ABOVB 5Z State Surchar:ge TOTAL 200 amps or less S 40.00 201 amps to 400 amps _ $ 55.00 Over 401 to 600 amps _ $ 80.00 Over 600 amps or 1000 volts see rrB'r above r clEIn ,""12h-\\Lq 00 00 00 00 $40 $40 s20 $36 RECEIVED BY: {5 4ng \2-7-ffi (q8s1q3- 1 p COMM ERCIAL/ IN DUSTRIAL PERMIT APPLICATION 225 Fifth Street, Springfield, Oregon 97477 LOCATION OF PRO ED WORK: ASSESSORS MAP: SPRINGF]ELE, JOB NUMBER INSPECTION Ll NE: 726-3769 OFFICE: 726-3759 TAX LOT: PHONE: 2KSTATE ztP lIoN I VALUE I 4zrz 71e DEMOLISH OTHER OWNER ADDRESS: CITY: DESCRIPTION OF WORK: NEW- REMODEL A NAME ADDRESS PHONE ADD RESS EXPI RES PHONE t CONTRACTOR'S NAME ARCHITECT: MECHANICAL: CONST. CONTRACTOR # GENERAL: PLUM BI N G PLU MBING NO_FEE CHARG E Single Fixture Relocated Bldg (new fix. addtl) Water Service ft Sanitary Sewer ft. Storm Sewer ft. Backflow Device TOTAL PERMIT MECHANICAL NO trtrtr CHA RGF Furnace/burner & vent < 100,000 BTUs Furnace/burner & vent >100,000 BTUs Floor furnace and vent Suspended wall or f loor mounted unit heater Appliance Vent separate Stationary evap. cooler Vent Fan/Single duct Vent f rom System apart AC or htg. Mechanical exhaust hood and duct Permit lssuance $10.00 TOTAL PERMIT LAND USE WATER HEATER: * OF UNITS: LIGHTING POWER BUDGET * OF BLDGS: OUAD AREA HANDICAP ACCESS: FLOOD PLAIN ZONING _ OFFICE USE -53rn OCCY GROUP: # OF STORIES CONSTR. TYPE: HEAT SOURCE: $/SQ. FT.VALUESQ. FT. TOTAL VALUE OF PROJ X X SQ. FTG MAIN SQ. FTG ACCESS SQ. FTG OTHER RCPT#PLAN CHECK FEE DATE BY BUILDING PERMIT b 5D PLUMBI NG DEMOLITION 5% State Su rcharoe q 5% State Surcharqe MECHANICAL FENCE VALUE $ 5% State Su rcharoe SIDEWALK FT. SUBTOTAL PERM ITS PAVING CURBCUT FT. SYSTEMS DEVELOPMENT "53TOTAL PERMIT FEES EXCLUDING ELECTRICAL 796 - // ELECTRICAL: I REQUIRED INSPECTIONS -It is the responsibility of the permit holder to see that all inspections are made at the proper time. To request an inspection, call 726.3769 (recorder), state your City designated job number, job address, type of inspection requested and when you will be ready for inspection. Requests received before 7:00 a.m. will be made the same working day, requests made after 7:00 a.m. will be made the following work day. SITE INSPECTION: To be ROUGH PLUMBING, PAVING: After gravel is in made after excavation, but ELECTRICAL & place but prior to placing prior to setup of forms. MECHANICAL: No work is to asphalt or concrete. be covered until these UNDERSLAB pLUMBING, inspections have been made SpEC;AL INSpECT;ONS: tn accordance ELECTRICAL & and approved. Section 306 0f the State Specialty Code MECHANICAL: To be made a special inspector shall be employed before any work is covered. ATTIC DRAFT STOPS & by the owner/ Contractor during CURTAIN WALLS cbnstruction of the following w6rk. A FOOTINGS & FOUNDATIONS: copy of the special testing reports shall To be made after trenches are FIREPLACE: Prior to placing be furnished to the Building Division. excavated and forms are facing materials and before erected, ail steet in ptace, but framing inspection' srRUcruRAL CoNCRETE: ln prior to placing concrete. FRAMING: To be made after excess of 25OO P.S.l. (306 a.1) coNcRETE sLAB: To be the roof' all framing' fire made arter ar insrab buirding 3l::5 ::.':fl 3i3:Ig"f,H;:r" EIX:,-TyJ3.,t,Y5tT',rrz uservice equipment, conduit, and vents are complete and :i?[,?'i:"XXti{:"i ?i:l""'YJ :X'. H::[flt"i;;,1,iJ;[3::: 3l?Xf],?E]uoT[,?,o,]l5:"0in place but before any tighteiing operations. (306concrete is placed. INSULATTON & VApOR a.6) BARRIER: To be made after all UNDERGROUND: Plumbing, insulation and required vapor SpRAyED ONelectrical, gas, sanitary sewer, barriers are in place but FIREpROOFING: U.BC.storm sewer, water and before any lath or gypsum Standards 43-g.drainage lines. To be made board interior wall covering isprior to covering or filling applied. S'ECIAL GRADING,t renc hes. ,NDERFL..R: p,umbins, I:::,fl'"="'f;m'J3[,Yi"' iX;fUTi[il,:ii",5Jb'i],"1 electrical, mechanical. To be according to plans. Chapter 29) made prior to installation of floor insulation, decking or LATH AND/OR GYPSUM GLU'LAM BEAMS: lnspection floor sheathing. - BOARD: To be made after all Certificate by an approved lathing and gypsum board, agency, furnished to the city,S posT & BEAM: To be made interior and exierior, is in Building Division before prior to installation of floor place but before any beams are placed' (2501 U'B.C' insulation, decking or f loor plastering is applied or before STDS' 25-1011)' sheathing. - Sypsum board ioints and fasteners are taped and STRUCTURAL MASONRY: (306 FLooR TNSULATToN & finished' a'7\ VAPOR BARRIERS: To be made prior to installation of decking or floor sheathing. MASONRY: Steel location, bond beams grouting or verticals in accordance with uBc 2415. ROOF SHEATHING AND NAILING: Prior to installing any roof covering. SIDEWALK & DRIVEWAY: Required for all concrete paving within street right of way, to be made after all excavating complete and form work and sub-base material in place. CURB AND APPROACH APRONS: After forms are erected but prior to placing concrete. "ln addition to the inspec- tions specified, the Building Official may make or require other inspections of any construction work to ensure compliance with the Building, City or Development Code. By signature, I state and agree, that I have carefully examined the completed application and do hereby certify that all information herein is true and correct, and I f urther certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springf ield, and the Laws of the State of Oregon pertaining to the work described herein, and that NO OCCUpANCy will be made of any structure without permission of the Building Safety Division. I further certify that only contractors and employees who are in compliance with ORS 701.055 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that project address is readable from the at the front of the property, and the approved set of plans will remai n on the site at all Signatu re ru ct Date ron street, that the permit card is loc times during const VALI DATION AMOUNT RECEIV RECEIPT *:RECEIVED BY: DATE PAID FINAL PLUMBING FINAL ELECTRICAL FINAL MECHANICAL FINAL FIRE DEPARTMENT SITE PLAN REVIEW BOARD: Must be requested 2 days in advance of the date you wish inspection. All project conditions such as landscaping, parking lot striping, etc. must be completed before requesting this inspection. v FINAL BUILDING: Requested after the final plumbing, electricat, mechanical and Fire Department inspections are made and approved. No occupancy of the premises can be made until a Certificate of Occupancy has been issued by the Building Division and posted on the premises. ADDITIONAL COMMENTS: -PLANS REVIEWED BY DATE 2 7- z- ,onEcoruC'fY OF 225 FIFTB STRBET SPRTNGFTELD, oREGoN 97477 INSPECTION REQT'BST.. 726-3769 0FPICE: 726-3759 SI'' IIN(;FtI:LTJ Job Number FEE SCBEDULE BELOS A. Nev Resi Ie or HuIti-Family per dr*,elling uni t. Service Included: Items Cost 1000 sq.ft. or less Each additional 500 sq. ft or portion thereof Each Hanuf'd Home or Modular Dvelling Serviee or Feeder $ 8s.00 s 1s.00 $ 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_ 0ver 1000 amps/volts Reconnect Only C. Temporary Services or Feeders Installation, Alteration or Relocation 0h AuthonieO 1. LOCATION OF INSTALLATION /4/4-UoLaLuK .Zlrd-,t Sum DESCRIPTION Permits are non-transferable and expirelf vork is not started vithin 180 daysof issuance or if vork is suspended for 180 days. -Y z. coMRAcroR rNsrALLATroN oNLy B. Electrical Contrac ro, lll rk^.,> lru* &n{L- /') Address (O,B,r t(( Ci D"I|*u,({" phone ?(e- {o{? Superv isor License Number 33?CS Expiration Date /o-/ - ?2- constr contr' Number 6szti Expiration Date ?- t9-q3 200 amps or less $ 201. amps to 400 amps _ $ Over 401 to 600 amps _ $ Over 600 amps or L000 volts se s s0.00 $ 60.00 $100.00 $130. 00 $300.00 $ 40.00 Signature of Supervising Electrician ,/,--t Crg-t 40.00 5s.00 80. o0 e ilBil above 0vners Name Address ci ty-Phone OVNER INSTALI,ATION The installation is being made on property I ovn vhich is not intended for sale, lease or rent. Ovners Signature: DATE: RECEIPT D. Branch Circuits Nev, Alteration or Extension Per Panel one Ci.rcui t I Each Additional Circuit or vith Service or Feeder Permi t $ 3s.00 $ 2.00 E. Miscellaneous (Service/feeder not included) -Each installation Pump or irrigation $ Sign/Outline Lighting_ $ Limi ted Energy/Res _ $ Limited Energy/Comm $ 00 00 00 40 40 20 3 5 SUBTOTAL OT ABOVE 5Z State Surcharge TOTAL ffio - *vLqhnr €oiarrlo RECEIVED BY: