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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 (}