HomeMy WebLinkAboutPermit Electrical 1997-11-24SPRINGFIELD, OREGON 9747
INSPECTION REQUEST:
OFPICE: 726-3759
726-3769
1. LOCATION OP INSTALLATION
0
SPhr^IGFtELO)
Ci ty Jo
3. COHPI,ETE FEE SCEEDTIIJ BELOV
A. Nev Residential-Single or
Multi-FamilY Per dvelling unit'
Service Included:
4r THIS PERMIT SHALL EXPIRE IFTHE
h
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED 0R lS ABANDONED FetrcrnrcA1, pERHrr Appl,rcArroN
.AY"fERIOD.
b Nurnber q 1 lu1)-
:1
lON I tems Cos t
$ 8s.00
$ 1s.00
$ 40.00
Sum
Permits are non-trans
if vork is not starte
of issuance or if vor
DATE:
ferable and exPire
d vithin 180 daYs
k is suspended for
1000 sq.ft. or less
Each additional 500
sq. ft or Portion
thereof
Each Manuf'd Home' or
Modular Dvelling
Service or Feeder
JOB DESCRIPTION
180 days.
2. COT.ITRACTOR INSTALI.,ATION ONLY
Electrical Contraetor
Address
cit *onetl4l - Akla.
Supervisor cense Number L',8 .\
Expiration Date o-t-q
Constr Contr' uu'U"r 3fl49
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less i
201 amPs to 400 amPs
-
401 amPs to 600 amPs
-
501 amPs to 1000 amPs-
over 1b00 amPs/volts
-
Reconnect OnIY
TemporarY Services or Feeders -
i;;'t;rI"iion, Alteration or Relocation
200 amPs''or less
201 amps to 400 amps .-
over 4b1 to 600 amP!
-
0ver 600 amPs or 1000 volts
Branch Circuits
-Each installation
pumo or irrigation .-
iisirloutf ine Lighting-
liilited EnergY/Res _-
Limited EnergY/Comm
SUBTOTAL OF ABOVE
5% State Surcharge
1z aa*inistrative Fee
TOTAL
B.
c
50. oos s0.00
s 60.00
s100.00
$130.00
$300.00
s 40.00
a566
$ 40.00
s ss.00
$ 80.00
see ItBfi
q-r -q8Expiration Date
Signa ture of SuPervising Electrician
0vners Name
Address
Ci Phone 4 Lbh -gt 5
OVNER
Nev, Alteration or Extension Per Panel
one Circuit $ 35'00
Each Additional-Eii"uit or vith Service - '
or Feeder P"t*i"o='" "L $ 2 ' oo 4' oo
Miscellaneous (Service/feeder not included)
The installation is being made on
Droperty I ovn "t'i'Ln is not intended
ior'saIL, lease or rent'
Ovners; Signature:
D.
E
.00
.00
.00
.00
o
s40
$40
$20
$36
o
RECEIVED
5 )-.,.lo
51h Jt"
ii 'i1.,i
) .li, ? .l
' 'i:{
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
Lot Typu
-
lnterlor
-
Corner
-
Panhandle
-
Cul-de-sac
IS THE PROPOSED WORK TN THE .
HISTORICAL DISTBIGT, OR ON
THE HISTORICAL REGISTER?
-
lf yes, thls appllcatlon must be slgnedand approved by the Hlstorlcal
Coordinator prlor to permit issuance.
APPROVED:
P,L.HSE GAR ACC'
N
S
E
VALUE
(A)
SO. FT.
Total Value
Building Permit Fee
State Surcharge
Total Fee
'ii t
X $/SQ. FT.
BUTLDING PERfiIT 'i
ITEM
Main
Garage
Carport
AND BUILDING PERMIT
Thls permit ls granted on the express condiilon that the sald
construction shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, includlng the
Development Code, regulating the constructlon and use of
bulldings, and may be suspended or revoked at any ilme
upon violation of any provisions of said ordinances.
Plans Reviewed By Date
E,LAN CHECK
Plan Check Fee:
BU I LDI NG
Date Paid:
Receipt Num
Received By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties withln the City limits which are belng lmproved.
ITEM
Flxtures
Residentlal Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
PLUMBING PERMIT
FEE
N'
FT.
(c)
ADDITIONAL COMMENTS
By slgnature, I state and agree, that I have carefully examlned
the completed application and do hereby cerilfy that all
lnformallon hereon is true ancl correct, and I f urther certlfy
that ariybnd arr work performed shalr be done in accordance
wlth the Ordinances of the City of Sprlngfield, and the Lawsof the State of Oregon pertalnlng to the work descrlbed
hereln, and that NO OCCUPANCy will be made of any
structure wrthout perrnission of the Building safety Divisron.I further certify that only contractors and employees who
are ln compliance with ORS 7O1.OS5 wlll be used on thlsprolect.
I further agree to ensure that all requlred lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permlt card ls located at the frontof the property, and the approved set of plans will remaln
on the site at all times during constructl
Slgnature
Date
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sldewalk __- ft
Curbcut
--
ft
Demolltlon
State Surcharge
Total Mlscellaneous Permits (E)
MECHANICAL PERMIT
(D)
No
,, -75 +- .q\
b_Ls-
&to,
Mechanical Permlt
lssuance
State Surcharge
Total Permit
Furnace
Exhaust Hood
Vent Fan
TOTAL AMOUNT DUE (exctudtng electrtcat)
(A, B, C, D, and E Combined)
VALIDATION:
RE6E,P1NUMBER
'ti
IIq'
2o
.<u,RECEIVED BY
AMOUNT RECEIVED
DATE PAID
FT.
Plumblng Permlt
State Surcharge
Total Charge
. FT.
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