HomeMy WebLinkAboutPermit Electrical 1996-6-25
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 ,B.
Electrical Contractor b&1v ~ fleS,!.lc.
Address P. D, ~o;t '1';$1 ~
City (!l.jelVt '11'101 Phone 9''3~. S"30j
Supervisor License Number ~~Iq 5
Expiration Date IO-I-IlS"
Constr Contr. Number 9q 5""1'1
Expiration Date ~ -20 - <tb
Zoninp L b t
DBte~ '4l.P
,
225 FIPTH STREET Author1z&j Signature
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3769
OFFICE: 726-3759
"
1. LOCATION ~F .)NSTALLAT):ON
L~9 _^'-/C~/~
LEGAL DESCRIPTION
/ 7~ '1 ,22.1.2- to/":Ie:; C:.
JOB DESCRIPTION
':)/"-'a~ FA,,"'. ....e~.
,
Signature of Supervising Electrician
~~fL
Owners Name
S t/ CA-A.)
/
~
[J ../I)ftfi,
Address
City Phone ?~ -f1J#f
01lNER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
DAn~=-rO-~Yr:tt.I(j----:~---- ----
RECEIn ll: \ 'f- _,.;} ,
RECEIVED BY: ~'-\L,'CL
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tLECTRICAL PERMIT APPLICATION
City Job Number 9S(]{i; ell
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 i-- $ 8S.00 e~
Each additional SOO
sq. ft or portion ~~
thereof ' --1-- $ lS.00 ~
Each Manuf'd Home, or
Modular 'Dwelling
Service or Feeder $ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to, 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
S 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00;
c.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps"oT less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 1000
.',!,,- -
L-- $ 40.00 ~.iHI
$ 55.00
$ 80.00
volts see "B" above
D.
Branch Circuits
"
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or wfth Service
or Feeder Permit
$ 3S.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
Sign/Outline Lighting $ 40.00
Limited Energy/Res $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE
Sr. State Surcharge
3% Administrative Fee
TOTAL
/7~~
~ .5'<:>
C.lo
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" ::'.f"~,-"",
.
.
-~~ or
~?... Willamalane
~g Park & Recreatio~ District
"
Job No.
q~c:r&ll
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAM."~j(\IH\~r~ . PHON.~A444_
ADDRESS, ~ ~ ~~~AJ~ \ ll~STAre ~P i{"J1JJ
'.
. .
LqaTION OF PROPOSED B}JILPJ~ SIlp." ~^ 1 .
Street Address if Known: LA:5l.fU U, (\ II \ f\\ f'\ (\ .J
~.
Platt N e:
Tax lot Number:
If)O~
1. DEVELOPMENT TYPE (Check appropriate dwellirig(sl. SDC calculations and dwelling type
definitions are on the back.l ' " ',', .
A. Sinl!ie Familv - Detached
+ Single Fan:'i1y home'
- NO OF UNITS I
Manufactured home not in a park" . (j)
X $400 PER UNIT.;=, ,,' $' .4[).
B. Sinl!le Familv -'Attached
.'
\ \
, .
NO OF UNITS
X $370 PER UNIT =
'$
C. Multi-Familv Aoartment.' .
NO OF UNITS
, .
X $~77 PER UNIT =
$
D. ManufactUred Home Park,
NO OF UNITS
X $280 PER UNIT =
$
,.' 4oo.aJ
,'. $
2. SDC CREDIT (If applicable) SDC-payer must fumish proof ofWPRD Credit,. ': IY
approval. See SDC Credit Worksheet. , ' $ <J
$1fDOO
WPRD SDC
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit.!
~A~ )~CDweJ
\0,\\ ,aV)'
.
. NO. Q5oS41
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY: <5 Y (.fHJ B C.O'RP
lOCATION: (~:;q ^-IICA-lt:JLA-~ VI!..
110 ? -Z 7.- I 7- - <',? aGo
DEVELOPMENT TYPE: /-l?L - ~~V <:-,j::/Z..
BUILDING SIZE:
I..OT SIZE
5Q. Ft.
1. STORM DRAINAGE
IMPERVIOUS SQ. FT.
-:?'2-0c;:.
X $0.209 PER SQ. FT, ~Cob9~
2, SANITARY SEWER-CITY
NO, OF PFU'S
(See Reverse)
1"'1
X $43,26 PER PFU
c-e,ZI"'.1-)
........... .--/
3, TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X
X
X $436. 19
X $436. 19
G 4%52)
"'- ------
$
$
I X f.ol X $436,19
4. SANITARY SEWER-MWMC
NO. OF PFU'S 1'1 x $17.19 PER PFU + $10 MWMC ADM FEE
(Use PFU Total From Item 2 Above)
$ "?'?G. C'oJ..
TOTAl-MWMC SDC
$ 'N/A
~
---- ......-
$ -z..-z..c::.!> 92
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
SUBTOTAL (ADD ITEMS 1,2,3 & 4)
5. ADMINISTRATIVE FEES
BASE CHARGE (SUBTOTAL ABOVE)
V ~LvL
~iP Burdic-k
SOC Coordinator
X .05
Date: ? I~, 10ft:::>
, ,
'TOTAl SDC
C Il?>~
------.'
$ "Z- '? '0 -z. '3~
~\
FIXTURE UNIT.C~I,CULA T~ T ~.BLE: Numberof New fixtures X Unit Equivalent = fixture Units
(NOTE: For remodels, calculate only theWl: addItIOnal flxtures) .
. NUMBER OF UNIT FIXTURE "
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
Bathtub."".....,.....,."......"..,...",..",.,..,.....,................ ,
Drinking Fountain................................ .... ........ .........
Floor Drain....,.................................,................, ........
Interceptors For Grease/Oil/Solids/Etc..~..............
Interceptors 'For Sand/Auto Wash/Etc........,......,..
laundry T ub/Clotheswasher......,......,...,...........,.....
Clotheswasher - 3 Or More:...................,................
Mobile Home Park Trap (1 Per Trailerl...:..:............
Receptor For RefrigeratorfWater Station/Etc........
Receptor For Commercial Sink/Dishwasher/Etc..
Shower, Single StalL.................,..............................
Shower, Gang.......,.""....... "".. ", .., ... ,. ,...,..... .............
Sink: Bar, Commercial, Residential Kitchen..............,..........
Urinal. StallfWall.................. ...........,........ ........ ...........
Wash Basin/Lavatoiy,' Single.... .'............,.......... ......
Toilet, Public Installation..........,....,...,...,.... ...... ..-..
Toilet, Private..................................................:....
Miscellaneous:
"l.
2
1
2
3
6
2.
6
'6
1
3.
2
l/Head
2
2
1
6
4
4-
z.
'2.
'?
"?
"2.-
~
TOTAL FIXTURE UNITS
,.,
~
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates,
Year
Annexed
Rate per $1,000
Assessed Value
Year
Annexed
Rate per $1,000
Assessed Value
1979 or before
1980
1981
1982
1983
1984
1985
$3.46
3,38
3.32
3.21
3.06
2.92
2,73
1985
1986
1987
1988
1989
1990
1991
1993
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
Credit io'r Parcel or land Only If Applicable
Improvement (if 'after annexation date)
,':,'
" '
X $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
=
CREDIT TOTAL = $ ..E.,/A
J
RESIDENTIAL
PERMIT APPLICATION
Inspections: 726.3769
Office: 726.3759
LOT:
.
BLOCK'
L--'
.
q~
JOB NUMBER
225 Fifth Streat
Springfield, Oregon 97477
TAX LOT:
SUBDIVISIOf'l..
_ n/8D1 Q
~\\(,\htlM'
PHON~:\~o.B"(\"'\
OTHER
ZIP: _gJ~EI}
CONT~ACTO~R'S NAME ~ADDRESS
GENERALi 0 y" a.f)
PLU~~ING~' .~l\ll\ r-:W-~ \roD
MECHAN1CA~ . Q:\'(\.}, 0 ~~
ELECTRICAI\' \.."t1\ f\~ '
CONST.
CONTRACTOR # '?,PIRES PHONE
q~l c!i .f)..S!Jb ~~'l~_
~r)llo~ B'I~q<0 2A'0.nm
~~Olog2 ~. ~\tl Q1 t\b llo 1J
9Pil2q ~. \\.C\tQ \oi~lM10
- OFFICE USE -
QUAD AREA: \~~}\O LAND USE: \\\ \ FLOOD PLAIN'
\ I f)e..;,
# OF BLDGS: # OF UNITS' ZONIN.G CODE:
OCCY GROUP: ~~ \.i\.. CONSTR. TYPE: UN # OF BDRMS: .~
. OF STORIES: I HEAT SOURCE: c=s SECONDARY HEAT:
WATER HEATER' €.,; RANGE: If..:> SQUARE FOOTAGE: B-~
To request an Inspection, you must call 726.3769. This Is a 24 hour recording. All Inspections requested before 7:00 a.m. will be
made the same working day, Inspections raquested after 7:00 a.m. will be made the following work day.
ClJ Temporary Electric
. . ,
o Sile Inspection - To be made
after excavatlon, but prior to
setting torms.
o Underslab Plumblng/Electrlcall
Mechanical - Prior to cover.
I\Tl Footing - After trenches are
L...-tJ excavated.
o Masonry - Steel location, bond
beams, grouting.
~ Foundation - After forms are
L.:j,J erected but prior to concrete
placement.
o Underground Plumbing - Prior
to filling trench.
~ Underfloor Plumbing/Mechanical
~ - PrIor to Insulation or decking.
~ Post and Beam - Prior to floor
'-'l<-' insulation or,dacklng.
rvl Floor Insulation - Prior to
~ decking.
I'Vl Sanitary Sewer - Prior to filling
I trench.
~ Storm Sewer - Prior to filling
I trench. '
f'lil Water Line - Prior to filling
L..-j::J trench.
~ Rough Plumblng.-:o Prior to "
LJ-J cover. ,."
REQUIRED INSPECTIONS
, fVl Rough Machanlcal - Prior to
L.f-' cover. ~-4S F ,.0, '
I\;l Rough Electrical - Prior to
/ ~ cover.
r\ft Electrical Service - Must be
~ approved to obtain permanent
electrical power. .
o Flreplaoe - Prlorto facing'
materials and framing Insp.
~ Framing - Prior to cover.
I"J. Wail/Ceiling Insulation - Prior to
~cover.
Q Drywall - Prior to tapi~g. .
',." .
o Wood Stove '- After I~stallatlon.
o Insert - After fireplace approval
and installation of unit.
M Curbcut & Approach - After
~ forms are erected but prIor to
placement of concrete. .
9 Sidewalk & Driveway - After
excavation Is complete. forms
and sub.base material In place.
o Fence - When compl~ted"
rYl Street Trees - When 'all requIred
~ trees are' planted. .' .. ,
rY9 Final Plumbing - When ,all
~ plumbing work la oomplet,';.
r-:::l Final Eleotrlcal - When all
L.A.J electrical work Is complete.
G;l Final Mechanical - When all
~ mechanical work Is complete.
I\7l Final Building - When all
L....,L.J required Inspections have been
approved and building is
completed.
o Other
MOBILE HOME INSPECTIONS
o Blocking and Set,Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
water and sewer.
o Electrical Connection - When
blocking, sat,up. and plumbing
Inspections have been approved
and the home is connected to
the aervlce panel.
o Final ,- After ali raquired
InsPQctlons are approved and
porches, sklrtln'g, decks, and
ventlng have been-Installed.
c...
Lot faces ..!Ill:. Lot Type . Setbacks {' .HE PROPOSED WORK IN THE
Lot sq. flg. ~ ~Interlor I P.L. HSE GAR ACC I --HISTORICAL DISTRIGr, OR ON
IN I THE HISTORICAL REGISTER?
Lot coverage ~oj~ Corner U 7.5 if yes, this application must be signed
~~". Is fa,c:' I and approved by the Historical
Topography Panhandle Iw I Coordinator prior to permit issuance.
Total height ~' Cul.de-sac 1~.2J' I,
IE 3tJ+ I APPROVED:
BUILDING PERMIT
::1: {lam
4~4
\9~20~ ~~20
IA.LO -CoSl4
Garage
Carport
Total Value
S6 1J-\1.\~
~ Lt. te..
'ill.
-:\~,
4S7~
Bulidlng Permit Fee
Sta.ta Surcharga ~.M:H~.l~
Total.Fee' . (A)
SYSTEMS DEVELOPMENT CHARGE (SD;J fia
., (B) *"l3e~ -
PLUMBING PERMIT
ITEM
FEE
Fixtures
Re~ldentlal Balh(s) N' ~
Sanitary Sewer FT.
Water FT.
Storm Sewer FT.
Moblie Home
\ c..n (,ll.L
Plumbing Permit
\(,..,r").~
L~L BO
\ 1~. ~
State Surcharge
8>-C.o"" J-\.eo
Total Charge
(C)
MECHANICAL PERMIT
. 7" ($-0
(p. -
.L\.,~
"1..c,u
Furnace
Exhaust Hood
Vent Fan
N'
?,
Wood Stovallnsert/Flreplace Unit
Dryer Vent
(7 t\ , . ,
\3" .u.b.....x..u.....:.. SF,,IJ,
~.c.O
tPfO
i Z cr.rJO
tJ'o
te:,. -
QJ2.
4/."':>2
MechanIcal Permit
Issuance
State Surcharge
r.4<;;+.~7
(D)
Total Permit
MISCELLANEOUS PERMITS
Moblie Home
State Issuance
State Surcharge
,.....
Sidewalk 3,5 It
~fl
l S~<;
\J..\..e,O
Curbcut
Damotltion
~.^ '
~~~'~X\D~ ~~
,
Total Mlscelianeous Permits
(E)
bO.f:>O
90. oS"
3/11-Y~
TOTAL AMOUNT DUE (excluding elactrical)
(A, B, C. 0, and E Combined)
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This permit is granted on the express condition that the said
construction shall, In all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Check Fee'
Date Paid: ~' LII ~)
Receipt Numbar: U-
Received 'By: ~, '
/AV)( , , ~ hD!e~~
PlanS-Reviewed By 7 c..."
Systems Development Charge is due on all undeveloped
properties within the City limits which ara being improved.
AQDIf'?NAL COMMENTS
\ VI) kn. /
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\J/1ll./11){: 'WS
(~: ~)!. p,rl. ~LI.J\
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_f' 1 Ll\ I\.L).l riD -?
\. '1),(Yl ~ (]f\ lo.::5_S rV(I}1()!(U)
( q Sn~3q '\ . I
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~~ Y~~AI'-1T /( ~O, i
By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that ali
Information hereon 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, and the Laws
of the State of Oregon pertaining to the work described
herein, and, that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division,
I further certIfy that only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project.
i
,
,
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,
I further agree to ensure that all required Inspectlons are
requested at the proper time; that each address Is readable
from the street, that the permit card Is located at the front
of the property, and the approved set of plans will ramaln
on the site at all tlmas during consyuctlon.
s~8.P^ ~~lAf'~,
Date &- 1/4&
VALIDATION: 1/;CLffl'
RECEIPT NUMBER r::x. () 1""1
DATEPAIf' r /J.f( ,C{t-;
AMOUNT REc~n'3' 7 '2..)$:,.'~ 8.
RECEIVED BY (f'ln ./
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'.
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