HomeMy WebLinkAboutPermit Electrical 1994-10-31
.
..
-
225 FIFTH STREET z~ning ~ ~7)t? _ ELECTRICAL PERMIT APPLICATION 9~12/.Z
SPRINGFIELD, OREGON 97477Dtlle T ,-'UV /O-jl-";t.J ~' f ~/(
INSPECTION REQUEST: 726-'U69 " I Ci ty Job Number. . '1 ~
OFFICE: 726-3759 Autho~zed Slgnatura 1.2";1/ . . .
. 1. LOCATION OF INSTALLATION *
~?7; -n ?n7/&;r~ 5~ :: ~e~:::d::i:::::eB::OV ,,: ...'
Multi-Family per dwelling unit.
LEGAL DESCRIPTION Service Included:
J7/1 2 <'4 2,;;: /)/) 2-c:ro Items Cos t Sum
JOB DEliCRIPTION
.7)L(/J~~
v, .'
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 ContractorVA.tb5 rkc.7~/C
Address ~)~67';/-
Ci ty 5/~l>
/7"c.,&. ,<;l.,<f /~~r
Phone
gcj16"-"3'f'r?-
/i7~.s
Supervisor License Number
Expiration Date
/tJ -/- '7.5"
Constr Contr. Number 7/7'7.?--
Expiration Date /,?- /J-''l~
Signa~~of su~rvising Electrician .
~_. ~//GM .
ow~rs Name ~~~ ~/~ D.
r .
Address
~i'<--r""'"
..--'
City
Phone
OVNER INSTALLATION
'\
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners' Signature:
D~Ti~~--------:l~~~~----------~
RECEIPT 1I: I G' ..t. en
RECEIVED BY: ~,
. 1000 sq. ft. or less 2- $ 85.00 120
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home or
Modula.r:Dwelling
Service or Feeder $ 40.00
B. Servi"ces or Feeders
Installation, Alterations
or Relocation:
200 amps or less $ 50.00
201 amps to 400 amps $ 60.00
401 amps to,,600 amps $100.00 -
601 amps to 1000 amps $130.00 .'
Over 1000 amps/volts $300.00
Reconnect Only $ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000 volts
$ 40.00
$ 55.00
$ 80.00
see "B" above
Branch Circuits
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lightin~
Limited Energy/Res
Limited Energy/Comm
not included)
"
40,00
40.00
20.00
36.00
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
J7/J.~
. ~.5"O
<t. (0
/'B-:- c,o
.
.
fi !!)!i!It!,~~!~!!~
JobNo. Q4\ 2B 2-
NAME:
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
~f\'L '-T""ttru . PHONE:-1n~<l~ .lJ~
PfI C'iJUD 1\ air! 0 c:1p I r > STATE I9:1LIP Cf11oL.
\\\t\~' ~tl
Tax Lot Number: \C\()~~43:\ m2rtJ
'(\. \r\ )
ADDRESS:
LOCATION OF I"ROPOSED ~UILDING SITEl-\c!:2.f'\n
. Street Address if Known: I.t:=) ~ 'I' I + ~ n I ~
Platt Name:
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC Calculations and dwelling type
definitions are on the back.l
A Sinl!le Familv - Detached
Single Family home
Manufactured home not in a park
NO OF UNITS
X $400 PER UNIT _=
$
"
B. Sirmle Familv - Attached
NOOF UNITS
A.
X $370 PER UNIT =
. $1J/),cO
C. Multi-Familv Aoartment
NO OF UNITS
X $277 PER UNIT =
$
D. Manufactured Home Park
NO OF UNITS
X $280 PER UNIT =
$
$!JfIJ ,CD
$f:Y
. (f)
$ 94ft
WPRD SOC
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet
3. TOTAL WPRD NET SOC ASSESSED (If SOC reduced for Credill
~o/J~~~
/C) / :</ / 9/
Date
(}