HomeMy WebLinkAboutPermit Electrical 1997-11-21
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DEvaOPMENTSERWCESDE~RTMENT
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
1.
LOCATION OF INSTALLATION
3..:>..:>Cj ('~-,WI~~ S+
LEGAL DESCRIPTION
1702..31 Z-I o1.o-oe
JOB DE~CRIPTION / . .
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Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor 't)"tttlf ~lP~
Address
LlO '54
sr~ ld.
'SOD....... ~tl-4iJ--"
Phone '7tl1-l77.tt.
LIlliS
Lo .. 0 , -0 I
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City
Supervisor License Number
~,.
Expiration Date
ConstrContr. Number
Expiration Date
I 0 ~t'}l -0 I .
. . Si~~ture of Supe~ing Ele rician
,( [) VJJl..J \ => \
- -
ers . Name k-t /~ C-Ie-t; L
Address J 7 SS-l> J-I,'-//5 Cret:f ~.
Ci ty spr';71 '~tJ Phone 7l1b' S~ZO
, )
OWER INSTALLATION
D.
The installation is being made on,
pioperty I own which is pot intended
for sale, lease or rent;
E.
Owners Signature:
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5~
DATE: '
RECEIPT #:
RECEIVED BY:
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SPRINGFIELD
225 FIFTH STREET
SPRINGFIELD, OR 97477
(541) 726-3753
FAX (541) 726-3689
ELECTRICAL PERKIT APPLICATION,
Ci ty Job Number 01-:00373.- 0 (
3. COMPLETE FEE SCHEDULE BELOV
A.
New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Items Cost
Sum
1000 sq. ft. or less.
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home or
Modular Dwelling
Service or Feeder
$ 85.00
$ 15.00
$ 40.00
t
B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less , .:, 2.-
201 amps to 400 amps ,;
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00 ICSO
$ 60.00 .
$100.00
$130.00
$300.00.
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 .amps
201 amps
Over 401
Over 600
or less
to 400 amps
to 600 amps
amps or 1000.
$ 40.00
$ 55.00
'$ 80.00
volts see"B"
above
Branch Circuits
New, Alteration or Extension Per Panel.
One Circuit $ 35.00
Each Additional
Circuit or with Service
or Feeder Permit 2,-0 $ 2.00 L/D
,"
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
SUBTOTAL OF ABOVE
. 7% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
/'10,
~5'f~
40 . 00 '
40.00
20.00
36.00
, PLAN REVIEW COMMENTS I SPECIAL INSTRUCTIONS:. '.
. 'RESTORATlON WORK SHALL BE IN CO"'MANCE WITH EXISTING CITY CODES AN.dbMPUANCE WITH CURRENT
STANDARD SPECIFIOATIONS, EXOEPT~OTED BELOW. ,'"
C 001 Backfill With ." mlnul rock.
_ 002 Compact .v.ry ~ S" 100.. d.pth.
__ 003 Raqulr.. comp.ctlon with a Itltl rolllar.
_ 004 A.C. to match the greatar of .xlltlng d.pth or 4".
.. 006 AU cutl ..al.d for f1nallnap.oilon.
_ 008. T.mporary p.tch m.y b. u..d .t the .nd of the day.
007 Signing and Zoni protection to comply with MUTCO
008 Cut concrete only on scora IIn.. or. cold Joints.
009 Sldaw.lks .nd drlvaWaYI mln. 3.000psl.
010 Curbing mln 3.600pall No patchwork lass than 3'.
011 Me'at min. r.qulrem.ntl on curb cutl. Spfd. cod..
012 Rlltor. plant.d,areas, Spfd. cod. 208.3.05
013 Sp.c. to Bor. I Jack I No A.C. cuts.
014 Mechanical compacting r.qulrad.
016 No patchwork allow.d.
018 Lat.ral cut. to have control d.nllty fill.
017 Cuta to b. polym.rlzed crack ..alad for final Inspection.
.018 Mlnlnum 2" cruahed rock ." mlnua.
-
018
020
021
022,
023
024
026
028
027
028
029
030
031
032
933
343
Comments:
,
,-'-;".
~ ~_: ,'t~.
,.
Mlnumum 4' clllranca at any point. Iwlng.away.
Concr.t. minimum 4" d.pth, 3,OOOpal.
Trench to b. "T" cut.
Neada Stata I County parmlt.
No .bov. ground .ncloalng. In sldawalk or handicap ramps.
Dlemond cut A.C./Concrete value box.. to grade.
Frllh 011 slgnl I Gradad.
Comply with Americans with Olaebllltlll Act.
Concrate slab.. 72hra. curing time, 4600psl.
Concrete slab. require Joint seal m.tarlal.
Driveway require. dow.ls .very 1 S".
Submit traffic control plan prior to excavation.
Notify Tr.fflc Division bafore .xcavatipn.
Cor. drill main I1n.. Inllrt tee, 2% min. grade.
Must comply with the provisions of ORS 767.641 to 767.671.
6" Circular hole/H2().Vac.
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t,
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YOU ARE REQUIRED TO CALL
THE lANE UTiliTIES COORDINATING COUNCil'S
"ONE CAll NUMBER" 1-800-332-2344
48 HOURS BEFORE DIGGING
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INSPECTIONS:
'0
CURB CUT AND SIDEWALK INSPECTIONS CALL 726-3769 (RECORDER) STATE YOUR DESIGINATED CITY JOB
NUMBER/PERMIT NUMBER. JOB ADDRESS, TYPE OF INSPECTION REQUESTED, AND WHEN YOU WILL BE READY FOR
INSPECTION, CONTRACTOR'S OR OWNER'S NAME AND PHONE NUMBER. REQUESTS RECEIVED BEFORE 7:00 A.M. WILL BE
MADE THE SAME DAY, REQUESTS AFTER 7:00 A.M. WILL BE MADE THE NEXT WORKING DAY. INSPECTIONS ARE TO BE
CALLED IN AFTER EXCAVATIONS ARE MADE AND FORM WO~K IS IN PLACE BUT PRIOR TO POURING CONCRETE.
o SANITARY SEWER, STORM SEWER, ENCROACHMENT PERMIT AND OTHER INSPECTIONS CALL CITY MAINTENANCE AT
726-3761.
SIGNATURE:
.'
AMOUNT RECEIVED: ~ ~/. ~
RECEIPT NO: -:z &"'~& 55
.
"
DATE PAID:
RECEIVED BY:
,..
/r7/"~'?
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By signature, I. state and agree( that I have carefully examined the completed application and do hereby certify that all information
herein Is true and correct, and I further certify that any and all work performed shall be done In accordance With the Ordinances of the
City of Springfield, applicable City Standard specifications and Drawings hand the laws Qf the State of OrejJon pertaining to the work
described herein. I further certify that only contractors and employees w 0 are In compliance with ORS 7U1.055 will be used on this
, project.
The City may InsJ:)ect the work site described In this J:!ermlt at :any time during a one year period following the receipt QY the City of
notice of, completion of the described work and ,pe~fy, at th$ City's sole delloresslon, any additional restoration work re~uired to
, return the ,Ite to a standard acceptable to the City. Tlie p,rmltte, will be notified In writing of any work required and will have thirty
, days (30) from the d~tQ ofbthe notice to cOfTlplete the work. Work not completed at the anet of the thirty days will be performed by the
. ' City and the costs will be l\Iled to the permittee, '
I furthor agree to ensure that all required Inspections are requ&ted at the proper time, that project address Is readable from the street.
and the approved set of plans will remain on the site at all times during construction.
, Slg:a~ ~" oat.' Itl2.d'!7 .
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VALIDATION:
0 TRAFFIC REVIEWED BY: DATE:
0 ENGINEERING ,REVIEWED BY: I, DATE:
0 MAINTENANCE: DATE:
0 PERMIT ISSUED BY; DATE:
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: FOR SIDEWALK AND CURB CUT PERMITS PLACE A COPY (COMPLETED) IN PERMIT DRAWER.
INSPECTION:
t
:, INSPECTION:
, WORK IN PROGRESS
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AT TIME OF COMPLETION:
ELEVENTH MONTH:
DEPOSIT RETURNED:
DATE:
DATE:
DATE:
DATE:
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DATE:
DATE:
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