HomeMy WebLinkAboutPermit Electrical 1994-06-27SP,lINGFIELORESIDENTIAL
PERMIT APPLICATION
lnspections: 726-3769
Office: 726-3759 Zfr,
JOB NUMBER
225 Fifth Street
Sprlngfleld, Oregon 97477
{f, r1
T,rY OF
?irThe follming proiect
zoning, snd iioee not
ae eubmltcd hc225 FIFTE STRBEf,
SPRINGFIET,D, ORBGON 97477
INSPECTION REQIIESTz 726.3769
0PPICE: 726-3759
requiro ep€cilic PERHIT APPLICATION
Ci ty Job Numbe, ?qd/-?
3. COHPLBTE PEE SCEEDULE BELOV
al-Single or
HuItl-Family per dvelling unlt.
Service fncluded:
Items Cost
approvel.
.z
1. L,CATI'N OF INSTALT-ATffir$iigoci s.ipratui.e_..1f,1-j[A. -.
"^ 5 Al' zf'o A. N;E;l?airl
I,EGAL DESCRIPTION
JOB DESCRIPTION
Z.m/+ *z<ttt c-L
2, COl[tRAg[OR INSTALT,ATION ONLY
Owners Nanie
1000 sq.ft. or less
Each addltlonal 500
sq. ft or portion
thereo f
Each Manuf'd Home or
Hodular Dwelllng
Service or Feeder
s 8s.oo
$ 1s.00
'z s 4o.oo &
.00
.00
.00
ee ilBil aEffi-
s 2.00
Sum
Permlts are non-transferable and expireif vork is not started vithln 180 daysof lssuance or if vork ls suspended for
180 days.
Electrical Contractor €l-rrt
Address t,Zo yvlr,+eo€
city guhet+6. enone ,(.(''59b1
Supervisor Llcense Ntimber )qLs
Explratlon Date
Constr Contr. Number TOZi:DC zo."-?oL
Expiration Date lL'
Slgnature of Supervlslng Electrician
€/,-r**/
B. Services or Feeders
Installation, Alterations or
4&17et C Relocat lon :
200 amps or less
201 amps to 400 amps _401 amps to 600 amps _
601 amps to 1000 amps_
0ver 1000 amps/volts
Reeonnect Only
200 amps or less $
201 amps to 400 amps
-
$
Over 401 to 600 amps _ S
Over 600 amps or 1000 volts s
$ s0.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
c Temporary Services or Feeders
Installation, Alteration or Relocation
40
55
80
Address
Ci ty Phone
D. Branch Circults
Nev, Alteration or Extension Per Pane}
s 3s.00
OVNER INSTALI,ATION
The installation is being made onproperty f own vhlch is not intendedfor sale, lease or rent.
Ovners Signature:
E. Hiscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $
Sign/0utline Lighting- S
Limi ted Energy/Res S
Limi ted Energy/Comm S
One Ci rcui t
Each Additional
Circuit or vith Service
or Feeder Permit
ST]BTOTAL OP ABOYE
5f State SurchargerorAl, l-v%
00
00
00
00
40.
40.
20.
36.
5 8o-oo
/.*,<*lo96.7a
i;;p;;ir-;*'h;;; ;;;; ;Jp'J,Ea
DATE:
RECEI
-/
PT
RECEIVED BI:
Slorm Sewer - Prlor to lllllng
trench.
Water Llne - Prlor to filling
trench.
lJ excavation ls complete, forms
and sub.base material ln place.
l-l Fence - When compteted.
Street Trees - When all required
trees are planted.
After all required
ons are approved andporches, sklrtlng, decks, andventlng have been lnstalled.
\and the home ls
the servlce panel
@,,,,,^Rough Plumbing - Prior to
cover.
/7€2,'Vr'zr2- &z€aa
,/
E
tl
E E
lit,l
Lot facos
Lot sq. ltg.
Lot coverage
Topography
Total helght
Lot Type
-
lnterlor
-
Corner
-
Panhandle
-
Cul-de-sac
, THE PROPOSED WORK lN THE
HISTORICAL DISTRI T, OR ON
THE H.ISTORICAL REGISTER?
-
1f yes, thls appllcatlon must be slgned
and approved by the Hlstorlcal
Coordlnalor prlor to permlt lssuance.
APPROVED:
PL.HSE GAR ACG
N
S
W
E
VALUE
(A)
Total Value
Bulldlng Permit Fee
Stale Surcharge
Total Fec
Maln
Garago
Carport
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
Thls permlt is granted on the express condltlon that the sald
construcllon shall, ln all respects, conlorm lo the Ordlnance
adopted by the City ol Sprlngfleld, lnctudlng the
Dovelopment Code. regulating the constructlon and usc of
bulldings, and may be suspended or revoked at any tlmo
upon vlolation of any provislons of sald ordlnances.
Receipt Number:-
Plans Revlewed By Date
Plan Check Fee:
Date Pald
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge ls due on all undeveloped
propertles wlthln the City limils whlch are being lmproved.
ITEM
Flxtures
Resldenllal Bath(s)
Sanllary Sewer
Water
Storm Sewer
Moblle Home
FEE
+4s
(c)
No
FT,
FT.
PLUMBING PERMIT
Plumblng Permlt
Stato Surchargo
Tolal Charge
ADDITIONAL COMMENTS
Wood Stove/ lnsert/ Flreplace Unlt
Dryer Vent
(D)
NoVent Fan
Mechanlcal Permlt
lssuance
State Surcharge
Tolal Permlt
MECHANICAL PERMIT
Furnaco
Exhaust Hood By slgnature, I state and agree, that I have carefully examlned
the completed appllcatlon and do hereby certlfy that all
lnformatlon hereon ls lrue and correct, and I lurther cerilly
that any and all work performed shall be done ln accordance
wtth the Ordlnances of the Clty of Sprlnglleld, and the Laws
of the State ol Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCY wlll be made of any
struclure wlthout permisslon ol the Bulldlng Salety Olvlslon.
I further certlly that only contractors and employees who
aro ln compllance wlth OFIS 701.055 wlll be used on thls
prolect.
I lurther agree to ensure that all requlred lnspectlons aro
requested at the proper tlme, that oach address ls readable
from the street, that the permlt card ls located at lhe front
the property, and the approved set of plans wlll remaln
st re
Date
o the slte at all tlmes durl ng construcllon.
2/-?/
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
Stats Surcharge
Sldewalk
-
ft
Curbcut
-
lt
TOTAL AMOUNT DUE (excludlng electrlcal)
(A, B, C, Q and E Comblned)
OO
315
ts (E)Tolal Mlscellaneous
Demolltlon
St ls-Slucba€o,
DATE PAID
FIECEIVED
AMOUNT
VALIDATION:
RECEIPT NUMBE
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
Recelved By:
FT.