Loading...
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