HomeMy WebLinkAboutPermit Electrical 1998-8-21
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225 FIITH STREET o-X"J11/1^
SPRINGFIELD, OREGON 97477 f. f\
INSPECTION REQUEST: 726-3769AulholVad~-U..h1
OFFICE: 726-3759 ~ U "7 '
::>P~ l"'\C~& COMPLETE FEE SCHEDULE BELOII
1. LOCATION OF INS ALLATION . ~~~~~)
.-::}-:2,/')5 /v\kl.l0 S-tRt:-C! A. Ne" Residential-Single or
Multi-Family per d"elling unit.
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
Permits are non-transferable and expire thereof
if "ork is not started "ithin 180 days Each Manuf'd 'Home or
of issuance or if "ork is suspended for Modular D"elling
180 days. NOTICE: Service or Feeder
2. CONTRACTOR INSTALLATION 0N\:J\6 PERMIT SHIlll E~HEiIESSifOWOOl€'ders
~~ ED UNDER "fl-I1~~'!Ir~SINotl terations
Electrical Contractor ~~~ '~ or Relo~atlon:
.'il j'':;''1J OR IS ABANDONED FOR
Address ,l"Z-l0 QAd,c.'PA.TCtiNv . ~v PERIOD. 200 amps or less $ 50.00
4 ~- 201 amps to 400 amps $ 60.00
Ci ty /2..U&t::~ Phone BS~tbTI7 401 amps to, 600 amps $100.00
601 amps to 1000 amps $130.00
Supervisor License Number -ZO.;;255CLS Over 1000 amps/volts $300.00
^ _ 1- n. Q. ATTOOR5\ll:t5r~91!>P,ta:w requiree l,n,"" $ 40.00
Expiration Date Iv -, () ~1I0.1esad~te~~theOrei~~~n
Constr Contr. Number Ill'2g{o ~otific 'hme~~ \1'1 R.~~atl~ ~ '~elocation
In OAR -Bo;- tl1 tnrou~F. u, tt::>~-6'ul-
;:2..( d- ( 0'1 0090. ~~nwprst>\5ljn ~~es of the rules bY$ 40.00
calli!!91h~m~!lt8(0(f'YRltr ~1~...I.v..v $ 55.00
numWei.lrItOOO~qro\:lti~~ ,;;;v",;;vn $ 80.00
o~en'61!l031nl!p!l-:m;!-:t . volts see "B" above
, JOB QESCRIPTION~lA ",.n'ALOlf'l',/
tL.Lut14.l AJ A'rEJ') I-V IV lJ JVI.{...VL T ~ 1:::'1'.1
Expiration Date
Signature ~perviSing Electrician
f' .A.J/'o .:: ....:Jruf).J
O"ners Name W~tJ ~rnomAL D.
Address 'fo \3) x. '2-'3'2-~5
Ci ty tZ'U~ Phone '3+1.-- c:zs ~ I
O\INER INSTALLATION
The installation is being made on
property I o"n "hich is not intended
for sale, lease or rent.
Owners Signature:
--------------t---r.--------------------
DATE: X 2/1'i' r :..3
RECEIPT 11: I . () V 1(, / / '
RECEIVED BY: oJ t.J
ELECTRICAL PERMI7\APPLICATION
r.i tv Job Number "'\ ID \ G 0
Items
Cost
Sum
$ 85.00
$ 15.00
$ 40.00
Branch Circuits
Ne", Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or "ith Service
or Feeder Permit
$ 35.00
$
2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00 40-
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE 'TO-
5% State Surcharge 2,-
3% Administrative Fee ~.~
TOTAL '-13. '2.0
SIGN 'PERMIT APPLlCATIO.
225 Fifth Street
Springfield. OR 97477
SPRINGFIELD
JOB.BER qXtXa?3
.
Inspection Line: 726.3769
Office: 726.3759
CITY:
STATE:
q,-P/ZI f0&t==-L~D
TAX LOT: /J."'l,CrJ _i4il IlJ
[
PH9NE: ~l- 02 g I
I
0YL. ZIP: C11401-
fvUaU.0le.. Ikt.-- rdA ~ s
SITE ADDRESS:
ASSESSORS MAP:
ADDRESS:
BUSINESS NAME, FIRM nc,:
DESCRIPTION OF PROPOSED SIGN(S): (please check and complete all appropriate information)
Wall ~ Freestanding _ Projecting Roof
_ Single Face __ Double Face _ Billboard Other
Square Footage: ~ ~.~ Total Height above Grade:
~ ~ I 10 l\
_ Marquee
List ALL eyisting signage and attach a photograph of oach sign: \Q ~ ~~
(aj Type C~btt..:& Sq. Ftg. ~Wm....y"b) Type ,,~
\. /
Sq. Ftg,
(cl Type
Sq. Ftg.
(d) Type
Sq, Ftg.
ADDRESS:
v..s~ A ~
,
1.1~lO ()AKf'kTCl-\ \{.b,
~U~
4rJ '" ,..,.. A I
PHONE: V'GI ................1..0
CONTRACTOR/lNST ALLER:
CITY:
STATE:
0Y2- ZIP: 0(14OL-
EXPIRES:~
EXPIRES: to f 30 I q 8
CONSTRUCTION CONTRACTORS REGISTRATION NUMBER:
4so3Q1-
- \ A iD.~,
Sign DistrictlliD~f'_, (\f\\\~J~~nd u~e: ~ill ') Ouad Area: ~\~./
Zoning: 9\ () Code Section: ~ . QJ rf)_
4r\ ~ Approved BY; UlJ7\ \ ( rh\t~ ;eAATE: A, IR ~
_ - _;n. rr - ---;- '~
. '\ '
It L'Z-bltJ
CITY BUSINESS LICENSE NUMBER:
OFFICE USE
Sign Permit Fee:
REOUIRED INSPECTIONS:
Site ~ting Attachment ~nal
to be made prior prior to placement after fasteners are
to sign placement of concrete installed/prior to cover
, \
Addition.1 Comments and/or Conditions:! (), 'It \ ~
~C\''t(f; :
, By Signature, I 5tate and \gree. that I have carefully examined the completed ap ic ion and do hereby c~tifY that all inlormation hereir
is true and correct. and I further certify that any and all work performed shan be one in accordance with the Ordinances of the City 0
Springfield. and the Laws of the State of Oregon pertaining to the work described herein, 1 further certify that only contractors an
employees who are in compliance with ORS 701.055 will be used on this project.
I further agree to ensure that all reQuired inspections are reQuested at the proper time. that project address. is readable from the street, th.
the permit card is located at the front of the property. and the approved set 01 plans will remain on the site at all times durinu the installatio
of the sign(sl. '
Signature .i2hO.A~~Q1M-: / I2StA.;:WC.'Date
,--- l) U ~-,e('{'L C~2-
Amount Received: ,l ?J . W Date Paid:
Receipt Number: tJ '7/1 (p /
shC\\q'2,
'8/'2./ ir'l /J
VtJ"J!
Validation:
Received By: