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Home My WebLink AboutPermit Electrical 2019-09-09225 FIFTE STREET SPRTNGFTELD, oREGoN 9]_477 INSPEGTION REQLTEST| 726-3769 OFPICE: 726-3759 1. LOCATION OF INSTALT,ATION 4 ,2 Parlz,er La.n-e DESCRIPTION INGFIELO BI..ECTRICAL PERHIT APPLICATION Job Nurnbe . Cfi7 AO 7 JOB PTION Permits at'e non-transferable and expir' if vork is not started vithin 180 days of issuance or if vork is suspended fo 180 days. 2. CONTRASTOR INSTALI.,ATION ONLY Ci ty 3. COHPLETE FEE SCffiDIILE BELOV A Nev Residential-Single or Multi-Family per dvelling unit. Service Included: I tems Cos t 1000 sq.ft. or less Each additional 500 sq. ft or portion thereo f Each Manuf'd Home. or Modular 'Dve11ing SerVice or Feeder i tt3 C?lo o Sum e r s 8s.00 s 1s.00 s 40.00 s 3s.00 s 2.00 Electrical Contracto Address 0, O.b nv 4fl5 d{ Ci ty Phone Sttt- 4$4-QO7( Supervi-sor License Number ll'Z t JLf Expiration Date to C. Constr Contr.umber Q* I q Expiration Dat 4 s I tri CIAIT ners Name I fi,r) t D lnn Address Ci ty Yhone 5Ct - 8rbZ OVNER INSTALLATION DATE: 200 amps or less S 50.00 zoi "ri" to 400 amps --l S 60.00 aoi ;;; to 6oo ,'np" -- Sioo.9g : 601 amps to 1000 amps- q1?9.99 over 1b00 amps/voIts - 5300.00 Temporary Services or Feeders Installaiion, Alteration or Relocation 200 amps"or Iess $ 40'00 oret abt to 600 amfrs I $ 80'00 0ver 600 amps or-1500-At= see rrB, a5i6 Branch Circui ts ; .' Nev, Alteration or Extension Per Panel Services or Feeders Installation, Alterations or Relocation: One Circuit Each Additional Circuit or vith Service or Feeder Permit SUBTOTAL OF ABOVE 5Z State Surcharge 3% Administrative Fee TOTAL B. The insrarlatio, i$lQliffiade on E. Miscerraneous (service/feeder not included proper-tyI.ovn,r.itHrsBEfr.r,f,r**mltepHElFTHEnmln"}"i:?1}::i:lq{.q9 ror sare, rease ol-AtllfibnzEDuNDEgTHtspERnnrrsi6izo"tii"""r,igrriing-l- i 1g BB W00vners signature: COMMENCEDORISABANDONEDFo*imited Energv/Res' u zu' ANylBgDAypEHloD. "i;ii;J nn"tEvzco'n* + s 36'00 5 t RECEIVED B I 1 telephone ./ This permit is required for any site activity in the flood plain and everywhere site alteration consists of fifty (5O) cubic yards of material or more andlor if a drainageway is affected, within City limits and This Side To Be Filled Oui by Applicant 'Do (Qcity of Springfield ZFzrl<r , springfield, oreson b97- ? /37LProperty Owner LL Phone: Permit Expiration Date: City ." Cuq State:C)-zZtplful Date of Application Address Site Address: ' 3+b tr ucB rax Map No, 17' OZ-,11 - & , JournalnumberapplicableLandUseApplication Tax Lot:@ Sourcs Location EXCAVATION, Quarrtity Destlnation: @b MatorialSupplior- GRADING, Ouantity Supplier Address Phone-Proiect Suoervisor O FILL, ouantity Et slTE PLAN Reouirert Data:ouantitv of material, Property lines ano descriptions, Tax map ano - lbt number, Sitti addrcss, Existing contourllnes, Proposed conlour lines, Existing drainage wavs. Prooosed drainaqe wavs, Siqnificant trees and foliagb, Giound cover, Soil types, Bui(dihgs,'septic s.ysr.eiirs, Sdwers, Areas subjqct to flooding,.Utitities, Areas subject to land slides, Proposed site improvements' tr tr tr tr tr DRAINAGE, POLLUTION AND EROSION CONTROL PLAN ADDITIONAL INFORMATION, SOILS & GEOLOGY PLAN, CROSS SECTIONS, REPLANTING PLAN PHONE STATECITY PHONE STATECITY ADDRESS: COMPANY NAME:_ PROJECT SUPERVISOR: COMPANY NAME:-- PROJECT SUPERVISOR: ADDRESS: gotL F^x 6A1-q/17OFFICE PHONE 6 EMERGENCY PHONE: CONTRACTOR NAME:LL CITY: RegistrationNumber: /O Explratlon Date: PHO MOBILE PHONE:-- STATE: On--, ztP: 14U- PROJECT SUPERVISOR: ln I understand that I or my successors may have future p.lanc for.my property. which may be anticipated orga1tjglql1_e{.11, this time. I understand that such future plans may require perlhits and d€velopem€ntlPProvals trom the Ulty. ol uprlngrlelo iuna-"i"tinJ rtrit not*ittriiunoins inv "'pproral of thib Larid and. Diainage.Altoration Per:mit (LDAP), that at tho time of lii'f"iii-o^ oiiuiuri oeiri6 6i rprr"iruti'tfre City may revlsw andieconsider all actlons.which lor my euccessors have ;;t;ili.;;;;;;;;"1io inis lonp. I understand tnat the City may aE I condition of qltYJylYro^.9pPJo_v_al, requir.e the . ^ . ^unJoing, chlnging, o, .oait[i,i",' ,,i unV."tions which t hive uhdcrtaken as a recult of tho city's approval of this LOAP. By signature, I state and agree, that I have carefully examined the.completed application and. do hereby certify that all in'forfration herein is truei"nd correct, and I further'certify that any andall work performed_shall.be done in accordance "jitt' i'nj Orai""nC"i of the Gtv of Springfield, applicable'City Standard specifications 6nd Drawings, and the laws of the ai;i;;i Oieg; pertiining ro th" wdrk dlscribed'herein. lfuhher csnify that only contractors and employees who are in compliance wittr'ORS 701.O55 will be used on this prbject' . The Citv may inspect the work sire described in thir parmit rt lny time durlg g ond yerr period following.thc rrcript bY , the city ol nbtice ol completion ()t rtre described work and rpcollyi.!t tho city'.s sola dcsecrrtion,,tny edditionll rtstoratron *ir["jqrir"J-io-r"tuin tri"-iiiu r, t, standiid acceptab-le.to irrg.Clty. The permittoe will be notified in writingof any work .;;;;;e;;d;rt tire ttririv libi ,rrvs from rho daie of tho notico do.comilete tho wo;k: work not completod at the ond of ih; ii irty A;y; witt Ue pertcirmed try'the City and the costt will be.billed to the permlttee. 0atc ,(,0 .:. that.project address is readable fromall required inspections sro roquastgd at ser ol plans will remain on th6 site rt allI further agre€ to ensure that and thethe streot, Signature F -l M, IJJo- Zo =M, IJJFJ IJJ U Z ET Mc oZ cZ 5 E,ulz =o ulF6 zo E, Ltl 5 az 5 oz IJJ =o ko lU TE fa LrJE oFz tr =ozoo CEol-o cc 2oo oz 5& ul CEf :,lr Lrl ccl kzgo 8A"?evwtt + q4o(oo7 , ADDRESS: DRAINAGE, E Storm,. E WETLANDS, Description FLOOD PLAIN, Zone: Date Ditih, EI CU rt, E Natural FLOODWAY, FEMA Community Panel No , FEMA Community Panel No.: $20.00 s30.00 $40.00 $40.00 For the first 10,000 cubic yards, plus $20.00 for eaih a(l(iitional 10,000 cubic yards or fraction thereof S220.O0 For the first 1OO,O0'I cubic yards, plus $20.0O for eabh;ulrlitional 1O,000 cubic yards or fraction thereof $34O For the first 200,001 cubic yards, plus $6.00 for 6ach additional 10,000 cubic yards or fraction thereof . c30.00 $30,0O For the lirst l0O cubic yards, plus C14,O0 for each additional 1OO oublo y.rd. or fr.otion th.r.of, 1116.00 lbr the llrst 1,0OO cublc yards, plut i12.00 for oleh ddditionEl 1,000 cubic yards or fraetlon thtreof, $264.00 For thc lir:;l 1O,0OO cubic yards, plus $54.00 for each a(lllitional 10,000 cubic yards or f raction thereof $750.00 For the first 100,001 cubic yards, plus $30.00 for each additional 10,000 cubic yards or fraction thereof itft*r Date Rcceipt Itc #goe No. b3 453L o^r",blztl f, 100,001 To 200,000 2OO,OO1 CUBIC YARDS OR MORE Received By: Grading Permit fee Received by +zo,Rr:ceipt No:_ Date:w PV*^MA@LwgAre{=T< Date: PLAN CHECK FEES: UP TO 1OO CUBIC YARDS 101 TO 1,OOO CUBIC YARDS 1,001 TO 10,000 cuBlc YARDS 10,000 To 100,000 cuBtc YARDS GRADING PERMIT FEESr UP TO l OO CUBIC YARDS 1O1 TO 1,OOO CUBIC YARDS 1,001 TO 10,000 cuBtc YARDS 10,000 To 100,000 cuBlc YARDS 1oo,oo1 To 2oo,ooo ?- ,. Estimated Volume Plan Check Fee: Date: Date: Date: Date Planrti tr tr Maintenance tr Building: d Ensineerins inl L Engineering: Maintenance: lssued by:.._Date Req,:uired FinaUnspeetions-' Date Date Date Date F EI M IJ.Jo- Zo -tF M IIJFJ tIJ U Z ?Mc cZ cZ 5 !3nd 1nq pralnagg, activity,as outlined in this permit has been completod in accordance withtne provtstons ot thls permit. h1N,fltdr?5?i3P"%"r%?tly.iltJf;rgy,,li"ed in this permit has not been compteted in accordance Land and Drainage activity was performed prior ro application for this permit. Accepted by:Date tr tr tr lr Side To Be rilleeothy Citylst a lrlc, z TEo uttulJ. ozo Eclzoo outBt! tllE azo l-o IIJo.oz LUoz Fo-utoo 1/6/',l998 tu @h Permit Nrrmber_.