HomeMy WebLinkAboutPermit Electrical 1999-05-24CITY OF SPF OREGON
SPBINGF!ELD
H:t?'g;g,r;:llij'Jm,qoor.*225 TIFTH STREET
SPRTNGFTELD, oREGoN 9
INSPECTION REOTIEST:
OFFICE: 726-3759
Ci ty
OVNER INS
DATE:
" Pl | -oD/ Ll
APPLICATION
6. 6V
1 TION OF T
LEGAL DESCRIPTION
uto
bytheO regon UtilitY
h
Permi
if vor iidiinqof issu
1E0 days.Centeris 1 -no0-gez
2. CONTRACTOR INSTALI.,ATION ONLY
El-ec t ri caf tractor ,5
Address
City Job Number
EEE SCMDIII,E BELOII
A. Nev dential-Single or
B.
c
D
SUBTOTAL OF ABOVE
5Z State Surcharge
3Z Administrative Fee
TOTAL
Multi-Familv per dvelling unit.
servMlTlGhtied:
TH IS PERMIT SHALL E#ffi T TH€flfthT
1 0 0 o A*trJ-IQB lZEp !'UCIE B I!!l fl=R U rB6ftlor
Each ffi[45[gp$ dQB nanNboruro ron
ifl;f['[V?do BAVILflloD. S s 1s. oo
Each Hanuf'd Home or
-Modular Dvelling
Service or Feeder $ 40.00
7 47,Zte
726
Zoning
Slgnature
rule
rized
3
Sum
_E
E
Ci ty Phone
Supe rv i s r License Number L ^7tr ,S
Expiration Date 0-o/-o I
Constr Contr. Nuru"t /C gl,4
Expiration Date t-2 -ol
siqnlt ure of Supervising Electrician
Owners Name
Address
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/voIts
-
Reconnect 0n1Y
Temporary Services or Feeders
Installaiion, Alteration or Reloeation
200 amps or less $ 40.00
over 4b1 to 600 amps
-
$ 80.00
Over 600 amps or 1000-vo1-ts see "B" above
Branch Circuits
Nev, Alteration or Extension Per Pane1
One Circuit $ 35.00
Each Additional
Circuit or vith Service
or Feeder Permit
-
$ 2'00
Miscellaneous (Service/feeder not included)
,
s s0.00
s 60.00
$100.00
$130.00
$300.00
$ 40.00
aL
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
-Each installation
Pump or irrigation $
signZOutline Lighting- q
Liilited Energy/Res
-
$
E
5
40.00
40. 00
20.00
36.00
()
RECETVED
o
(
This permit is required for any site activity in the flood plain and everywhere slte alteration consists of
fifty'(50) cubic yards of material or more and/or if a drainageway is affected, within City limits and
This Slde To Be Fitlled Out by Applicant /l 'i' i "t',1-,"i'
i r-t,5 p t t - ery of Springfield
b-Cal
Sprlngfield, Oregon
S.
\
Date of Application 5 Z,l,t
Site Address:
wner
Expiration Date: '
u.lo- Phone: 1Property O
Address :
tr uGB
Journal number applicable Land Use Application
Tax Lot:tu7pTax Map No:
tr
trF
Source Location
Material
Phone-
Suppl ter
Project Su
F!LL, Ouantity-=O *--,
GRADING,
EXCAVA TION,
Address
Destination:
E(
tr
tr
tr
tr
tr
DRAINAGE, POLLUTION AND EROSION CONTROL PLAN
es
S ITE
lot
sl ides,
CROSS SECTIONS,
SOILS & GEOLOGY PLAN,
REPLANTING PLAN
ADDITIONAL INFORMATION,
COMPANY NAME: ,
PROJECT SUPERVISOR:
STATE
CITY STATE
PHONE
CITY
PHONECOMPANY NAME
ADDRESS:
PROJECT SUPERVISOR:
ADDRESS:
'1..{g -r:rO1".1
,L Z)
s
(l-
r.., .
zlP: Qf q,*lf oFFtcE PHoNE
PHONE 1{b -o,o G Y
, EMERGENCY PHONE: -1*lG*9a1. \
Expiration Date:Registration Number:
CITY:
CONTRACTOR NAME
I'OPROJECT SUPERVISOR:
MOBILE PHONE: 51\^t.rt9
ADDRESS:
STATE:
l.understand that I.or my succossors may have future plans for my property which may bc antlcipatcd or unanticipatcd atthis tim6. I understand that such future plans may roquire pormitsand devdlopemcnta-pprovale fiom the City of Springfleld.I understand thrt notwithstanding any approval of this Land and Drainagc Altbratlon P6rmh (LDAP), thlt Et itre tirire oiapplication of luture permits or approvals the city may roview and recoislder all astlons wni:n t oi mi ruccirrori hiveundenaken p€rsuant to thig LDAP. I understand that the City may as a condition of any futurc aoorovil. reoulra rhaundoing, changing, or modification of any actions which I hive uhdertaken as ! resuh bf the Chir'e appiovai of thb LDAP.
FEI
M,
I.JJo-
Zo
EIF
M,
IJJFJ
IJJ
U
Z
EI
M,c
cZ
oZ
5'
By signatur€., I stat_e and agree, that I hate.^frefully examined the complot€d application and do hereby ."rtity tdiat
"ttinformation herein is true an^d_ cortoct, and I further'cortify that any and all wort'performea itratt Ue done ln adcorainiewith the Ordinances of th6 City of Springfiold, applicable'City Standard specifications ana-O-iiwlnss, ind the lawJ ot Gestate.ot oregon p-egrining to_the wdrk doscribed herein. lfuhher cenify that ontyiontrocro;;d;ili6y;;;;i;;;;'i;compliance with ORS 7O1 .O55 will be used on this project
at an-y timo.dunrlg -! onc ycar pcrlod followlng the recelpt byspecify, at th€ City's eolc decccratlon, any ad-ditlonal reitorition
the. City. The permittae wlll bc notlfied in-writing of ony work
notice to...complctc the work. Work not completdd at thb end ofwill be billed to the permlttee.
+q
agro€
the street,
Ztt
I further aro roquosted at thlt prorcct addrcar lc readablc fromon the site at all
Dats )Signature
thlt rll
cc
TUz
=o
u.lF6
zo
TEut
5
6z
5
al-z
lrJ
=o
E
oulE,
fatr,
CE
a
z
5fU'zoo
EoF()
E,Fzoo
oz
5o-
lU
CE
uJ
ccf,kzg
U'
1
KB 3lD
and
land
andof
to
FAX ,A\_
8116
.l
w
wtr
DBAINAGE, E Storm, O Ditch, O Culvert,
WETLANDS, Descriptio " NOne
FLOOD PLAIN, Zon", (f . ,rrfroCommunity ,un"r*n'M
FLOODWAY, FEMA Community Panel No.: _, Date:_
tr O Natural
$20.00
$30.oo
940.OO
$4O.OO For the first lO,OOO cubic yards. plus
$20.00 for each additional 1O,O0O cubic yards or fraction thereof
922O.OO For the first 1OO,OO1 cubic yards, plus
92O,OO for each additional lO,OOO cubic yards or fraction thereof
$34O For tho first 200,001 cubic yards, plus
$6.00 for each additional lO,OOO cubid yards or fraction thereof.
s30.oo
$30.00 For the first 1 0O cubic yards, plus
$14.00 for each additional 100 cubic yards or fraction ther6of.
$156.00 For the first 1,OOO cubic yards. plus
$12.00 for each additional 1,000 cubic yards or fraction th€reot.
$264.00 For the first 1O,OOO cubic yards, plus
$54,OO for each additional 1O,OOO cubic yards or fraction thereof
$750.00 For the first 1OO,OO1 cubic yards, plus
$30.00 for each additional 10,000 cubic yards or fraction thereof
Date:
6?8.&
Kg
r\ 1'.^(a
,*"ab1110
Date
Date:
Receipt No,353lO
Receipt ruo:3ttol3 t4 qq
Plan Check Fee
Received
100,001 To 200,ooo
2OO,OO1 CUBIC YARDS OR MORE
1,001 TO 10,000 cuBlc YARDS
10,000 To 100,000 cuBlc YARDS
roo,ool To 200,ooo
Received by:
Estimated Volume:
Grading Permit fee:
PLAN CHECK FEES:
UP TO IOO CUBIC YARDS
101 TO l,OOO CUEIC YARDS
1,001 TO 10,000 CUB|C YARDS
10,ooo ro 100,ooo cuBtc YARos
GRADING PERMIT FEES:
UP TO lOO CUBIC YARDS
101 TO 1,000 CUBIC YARDS
s;P +dehrtsI<,4
2sz--
tr
tr Maintenance:
Date:
Eansineering
( ,,.nn
Date:
Date
Date:
Pormit Number lssued by:Date:
Date
Date
Reqrrired Final Inspeetions-'
Date
Date:
Planning:
Engineering:
Building:
Land and Drainage activity as outlined in this permit has boen completed in accordance with
the provisions of this permit.
Land ond Drainage aqtiyity as outlined in this permit has not been completed in accordance
wlth the provlsrohs ot tnl$ permlt.
tr Land and Drainage activity was performed prior to application for this permit
Acceoted bv: Date:
tr
E
F
-l
M,
IJJo-
Zo
-rlF
rv
-tIJFJ
tIJ
U
Z
EI
M,o
oZ
nZ
s
1/6/1998
q
Building:
Ort ide To Be Filll O City
lrJo
z
cco
ttJ
lrJl!
U'zo
a-zo
C)
oul
=UJ
tu(E
Maintenance:
tuoz
Fo-ltloo<
I