HomeMy WebLinkAboutPermit Electrical 1994-4-15
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The 1ollowing project as suo m~~Hi\~iand
zoning. nnd does not require ,...-
approval, L D rL
97477 ZoninlL
726-37~te6.-1 S-Ct.q . Ci ty Job Number
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AuthorizedSignalure 3.1- <.Ol......u. .<:i1. ~~HEDULE BELOIl
LOCATION O~ INSTALLATION 11
957 r /{)~"'l-ue\()(...~ NU6 A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
.,
225 FIFTH STREET
SPRINGFIELD, OREGON
INSPEctION REQUEST:
OFFICE: 726-3759
1.
. LEGAL DESCRIPTION, J .
/7 03. ~ in I Z. ,...g Z-7
JpI} DESCRIPTION /I ..
K~ In~.....u rioO \ ~
Permits are non-transferable and expire
if york is not started within 180 days
of issuance or if work is suspended for
180 days.
!
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor /L ~
Address 'l;)O;) 0 ~ 11+
~ity ~lJ(,('J' Phone ~ 'Xfo...;).3bS"'
Supervisor License Number .=<:;)!r,;) S
Expira t ion Da te 10 - / - c; fa
Constr Contr. Number c20 ;'1</',)'(,
Expiration Date /0/Q3
, /
Sign~~~~lectrician
Owners Name mc..~L (' -::0" \~ '\
B.
sL...~
..
Address
City Phone
OI1NER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~~ t, ~~~'J15;'~-:
RECEIVED BY: ~, -'- llA:.../ ~
~ -
ELECTRICAL PERMIT APPLICATION
Q3!L1-8CL
I
Items
Cost
Sum
0<"00
1000 sq.ft. or less --L-- $ 85,00 ~
Each additional 500
sq. ft or portion
thereof $ 15.00
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 .
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
~ 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
S 80.00
see "B" ab'Ci'V'e
D.
Branch Ci rcuits
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 not included)
-Each installation
Pump or irrigation $ 40.00
Sign(Outline Lighting $ 40.00
Limi ted .Energy/Re's, $ .20.00
Limited Energy/Comm - - $ 36,00
('",..cO
5. SUBTOTAL OF ABOVE <X::I
5% State Surcharge "1-""':5
TOTAL "''':;;</ ~
~
.""j l' JOB NO. !I~";~
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
NAME OR COMPANY:
LOCATION: t:fS7
tVIl/<.E... f SuE ~W(N;'
N~nI,(,lfXTE. /70 ~ ~ l~ - '-f. 2; '2-7.-
DEVELOPMENT TYPE:
II4Gl..J.Jo/!.<;. eAve.S
BUILDING SIZE: 1-U./1J . ,'f;(. to
,
I. STORM DRAINAGE
IMPERVIOUS SQ, FT. '/{;O
LOT SIZF SQ. Ft,
ot.p P6t.> ~ff,
87-n ~ ~
X $0.192 PER SQ. FT. \.S. ~'!>!:.) 'Z.t9f;'
-- --
2, SANITARY SEWER-CITY
NO, OF PFU'S
(See Reverse)
X $39,78 PER PFU
c -)
---- ---
3, TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X X $401,05 C; -- ')
-- --
X X $401.05 $ ~
X X $401.05 $ ~
SUBTOTAL (ADD ITEMS 1,2, & 3) $ ~ 1l ~;
4, ADMINISTRATIVE FEES c:x.P t.:V~.u..>
BASE CHARGE (SUBTOTAL ABOVE) X .05 ~'2? ~ 'Ie) ./~
e?<t? ..... --
~9. i> <I TOTAL-CITY SDC $ qZ 7<1 "3.(0
5. SANITARY SEWER-MWMC
NO. OF PFU'S x $13,62 PER PFU + $10 MWMC ADMIN, FEE $
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
~~L~
U Kip Burdick
SDC Coordinator
s-<f-tj"?
$
TOTAL-MWMC SDC~ --~
<., --
TOTAL SDC $ q z 7':!:.. ?,p
.. ,_. [ ,
-. -
'" , .
FIXTURE uNri CALCULATION TABLE: Number of New Fixtures X Un! uivalent = Fixture Units (NOTE:
For remodels, calculate only the NET additional fixtures)
FIXTURE TYPE
Bathtub.. ......,.. ,.. .............. ,............. ,.. ........ ,................
Drinking Fountain.........,.,...."..........,.......... ....,...,..,..
Floor Drain......,.........................,............,.............,....
Interceptors For Grease/OiI/Solids/Etc..".."..,....,..
Interceptors For Sand/Auto Wash/Etc..........:..,:.., .
Laundry Tub /Clotheswasher.....,.............................
Clotheswasher . 3 Or More........,..,....,..,.......,..,......
Mobile Home Park Trap (1 Per Trailer),..,........,..,..
Receptor For Refrigerator /Water Station/Etc,......,
H~ceptor For Commercial Sink/.DisQwasher/Etc..
Show'er, Single Stall..,...........',...,:.,;,:,...'.,.....,....,......,
ShOwer, Gang:..:, ................,. ....,...:....:..,.:..........,..,....
Sink, Bar, Commercial.....,......,....,..,.....,....."...,..,....
Urinal, Stall/Wall.........,.............,.,...................,.....,...
Wash Basin/Lavatory, Single",........,..............,......,
Water Closet, Public Installation..,....,..,....,........,....
Water Closet, Private.,.,.............,.,..,..,.......,..,..........
Miscellaneous:
"'-. .
~ . . '
NUMBER OF
NEW FIXTURES
UNIT
EQUIVALENT
.......
,
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
'.
1979 or before
, ,.1980
... .
1981
": '1982
1983
','\1984
$2.83
2,76
2,71
2,60
2.46 . ,_
2.33
'. ~. ....
'.
~'
~
Credit for Parcel or Land Only If Applicable
Improvement (if after annexation date)
,", 'c"
". ~ . ~,
. ",!' ~. . ' \
2
1
2
3 ,
6
2
6
6
'1
3
2
1/Head
2
2
1
6
4
: ".
," . ,1.
~. :-
,'" ,"\
,
.
. ~I ...,
:-,.J'
" .
, "
. ,
TOTAL FIXTURE UNITS
Year
Annexed
1985
1986
1987
1988
1989
1990
1991
x $
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
CREDIT TOTAL = $
. ,
y,
RUNOFF COEFFICIENTS FOR S,TORM DRAINAGE
Residential...,.., .........'...,..,..,.....,..,....... ..,..,......, 0.4
Commercial...,.......................,...........,..,..,......., 0.9
I nd ustrial...,....., ......,.... ......,..,.......... ..,.......,..,.... 0.45
Governmental.................,..,..................,.....,...., 0,5
IMPERVIOUS AREA = TOTAL LOT SIZE X RUNOFF COEFFICIENT
Rate per $1 ,000
Assessed Value
$2.16
1.90
1.60
0.25
0.87
0.50
0.16
.
, ,'.
I
I
RESIDENTI~L
PERMIT APPLICATION
I
Inspections: 726,3769
Office: 726,3759
I
.
SPRINGFIELD
~~
LOCATION OF PROPOSED WORK: 95;7 ~lJ.w~ e_
ASSESSORS MA'P: \ '"'\ O~ <rl-. ( .... \ ll. ;
OWNER' Jt1/f:e.. -i SVe..... MV,'Vt5"
ADDRESS: '-1<::7 ,~i-tbJ=ild1--e..
CITy_tfh'i/J" ..t:i;,~:I) /JJ..U~1tJ
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DESCRIBE WORK: ~)c! 61"l ,~WtlY k01Y\
ADDITION ,X- DEMOLISH
, &l)L. + j.f.1(CONST.
CONTRACTOR'S<NAME All"'. / ADDRESS r~ -'i1it'. CONTRACTOR'
GENERAL:Jfb/c.-i!- ~ fS'S"1Lb'.A1~~!3" UOtfl
P:UMBING: /Jon l"""Jj" S:OO__~rVlf(/ld1167t
MECHANICAL: An e- -
ELECTRICA,!.,; !i2/)'L... w.-sJ:.f.w. ~+h
/Vt!'V t-tL)/ E7,-c.; c..
LOT:
NEW
nEMODEL
OUAD AREA'
. OF BLDGS'
OCCY GROUP: _.12' ~"3
. OF STORIES:--1
WATER HEATER'
BLOCK'
STATE: -tlJ7
i
OTHER
.
C\'J",.f'''-lO'('\
JOB NUMBER' Q.J l"D.......1
225 Fifth Street
Springfield, Oregon 97477
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/TAX~: l\"7-J f6:Z
SUBDIVISION:
PHONE: -1Z-" - 8'60 I
6-~'2:%S-
ZIP'
&dh~Wl.
I!II1 kl-~,. )
EXPIRES
~~f!
6-in
PHONE
7'2.( -9(r;>/
(~-IW
2fJ~
C~G-?16-~
t:.~ c....
I 0-1 Lj $ <-
,/0 ~'i(
REQUIRED INSPECTIONS
[Xl Rough Mechanic;:al - Prior to
cover. .
[ll Rough Electrical - Prior to
cover.
o Electrical Service - Must be
approved 10 obtain permanent
electrical power.
o
Fireplace - Prior to facing
materials and framing Insp.
- OFFICE USE -
LAND USE:
FLOOD PLAIN'
. OF UNITe:. ZONING CODE:_
CONSTR. TYPE: _~ . OF BDRMS:
HEAT SOURCE: ~t'?CJ'- iJt;;4? SECONDARY HEAT:
t1ANGE:
SQUARE FOOTAGE:
To request an inspection, you must call 726-3769. This is <1 24 hour recording. All Inspections requested before 7:00 a,m. will be
made the same working day. Inspection::; rcqllcstcd after 7:00 a.m. will be made the following work day.
o Temporary Electric
o Site Inspection - To be made
after excavation, but prior to
setting forms.
o
Underslab Plumbing/Electrical!
Mechanical - Prior to cover.
[Xl
D
Footing - After trenches arc
excavated.
Masonry - Steel location, bond
beams. grouting.
[4J
Foundation - After forms are
erected but prior to concrete
placement.
o
Underground Plumbing - Prior
to filling trench.
CKI
Underlloor Plumbing/Mochanicar'
_ Priol to insulation or decking:'
14l
OJ
o
Post and Boom - Prior to floor
Insulation or decking.
Floor Insulation - Prior to
decking.
Sanilary Sewer - Prior !o fitlir:;]
Irencl).
o
Storm Sewer - Prior to fl:l1ng
trench.
o Water Line - Prlor to filling
trench.
rVl Rough Plumbing -. Prior to
~J ~over,
cg]
Framing - Prior to cover.
Xl Wall/Ceiling insul;:tion - Prior to
cover.
CXf Drywall - Prior to taping.
o Wood Stove - After Installation,
[-lln::;crt -- ,\ftcr (ircpl.1.cn npproval
.- <1:1d :l1s~a!li'ltion of (Jni~.
Cl Curbcut ..... J\pprOJ~il -- Aitc:-
- tarms ar'J ~"'~cted tout prior to
placerncnl of C()l1cr.;le,
ri Sidewalk & Qrivc.-wav - Alter
C>:C3v~lion i:-.> compll.:i0. forms
~nd 3'.:b'U3se 11~::);teria; ]:1 ::!ace,
I! Fence - Whon ccmpleted.
~J
i -.'" Strpel Trc~s - V':!~C'n ~II rer,g.:ircd
--' Ire,;,:.> ~lm ~!anteq. .
rY1 Final Plumbing - When all
L,C::J plumbing work Is complete,
IYI Final Electrical - When all
L.,LlJ electrical work Is complete.
OJ
Final Mechanical - When all
mechanical work Is complete.
~
Final Building - When all
required Inspections have been
approved and building Is
completed.
OOthcr
MOBILE HOME INSPECTIONS
fi Blocking and Set-Up - WIlen all
blocking Is complete,
o Plumbing Connections - When
hOr!lc has been connected to
water and sewer.
o Electrical Cc~ncction - When
blocking, set-up. and plumbIng
inspections havQ been approved
and the home is connected to
the service panel.
r -I Final - After 311 required
inspectlr.)ns are approved and
porches, skirting, decks, :md
lJe!'ltlng have been inslallcd,
J
.
Lot faces
-Lr... Lot Type
7261~ _ Interior
2L
~.~
13~ I'
N
, .
Lot sq, ltg,
P.L
Setbacks
HSE GAR ACC
.
IS"rHE PROPOSED WORK IN THE
HISTORICAL DISTRICT, OR ON '
THE HISTORICAL'REGISTER?
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IvV _ ~, , ~.,J" '" ~. ~
-- ---;- - -=*---: : . - '
I E IP__~~, I APPROVED:
BUILDiNG VALUEj.PLAN CHECK
'AND BUILDING PERMIT
Lot coverage
Corner
Topography
Total height
Panhandle
CuI-dc-sac
BUILDING PERMIT
ITEM SO. FT. X $/SO. FT.
VALUE,..,
Main
Garage
Carport
~
3Jl!o
~
..., 9''I.'5"~
J'.1l<i-
.~~~,
\ '
SYSTEMS DEVELOPMENT CHARGE (SDC)
tJ'-P e"?~~;'A/ew 1.2,7'1(B) . ~::fJ.!..lP,
PLUMBING PERMIT
Total Val ue
'-e1' P
N&'W
Building Permit Fee8AS~
nS;-
8.?r
State Surcharge
i"~
, Total Fee
(AI
ITEM FEE
Fixtures ~ ~ #it>
-
Residential Bath(s) N'
Sanitary Sewer FT.
.
Water FT,
Storm Sewer FT.
Mobile Home
d4V ,yew ....~-
Plumbing Permit ~~- ~-
State Surcharge ~. /.~ - .sz,
Total Charge (C) ..::::..../CJ,5b
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
/
Wood Stove/Insert/Fireplace Unit
Dryer Vent
Issuance
~
.17'
/e>
.7S'" '7~
-& ~
';;l~7>(D):27:7> - -
Mechanical Permit
tP<.v
/1>
/0
State Surcharge
Total Permit
MISCELLANEOUS PERMITS
Mobile Home
State Issuance
State Surcharge
Sidewalk
It
Curbcut
It
Demolition
State Surcharge
Total Miscellaneous Permits (E)
TOTAL AMOUNT DUE (excluding electrical)
(A, B, C, D, and E Combined)
9/.~
If yes, this. application must be signed
..and' approved" by, the - Hislorical
'Coordinator pri~r.t~'permd issuance.
'!
":rhis permit is granted on the expre~s condition that the said
construction shall, in all respects, conform to the Ordinance
adopted by tile Cily of Springfiel~:' including the
Development Code, regulating the construction and use of
bulldin{:ls, ancJ may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Plan Clleck F~c: \ I 3 ,,5
~~J.3.) c,?,
~IIO
Date Paid:
Receipt Number"
" Rec~ By: ,.-- \DE)
~~Ji : ;-
"::",L.Pf"",,~ ~ ::...;7
'~s F-~e~~
--,. /-.....
~ ..~ '-/ .--'
D'ate.
Systems Development Charge Is due on all undeveloped
properties within the Cily limits which are b~ing improved.
ADDITIONAL COMMENTS
~~/~ /~/#- /
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_~A?",-r/~~ .~,;? OA/ye
9':2L??~
I
By signatulC. I state and agree, that I have carefully examined
the completed application and do hereby cerliry that all
information hereon is true and correct, and I further ce~tjfy
that any and all worK performed shall be done in accordance
wittl ttle Ordinances or the City of Springfield, and the Laws
of the S:3tC of O~cgon pertaining to the work described
herein, and tHtlt NQ OCCUPANCY will be made of any
structure wlthout permission of the Building Salety Division.
I furtht:'r cerlify Blat only contractors and employees who
arc in compliance with GRS 701.055 will be used on thIs
project.
I further agree to ensure that all required inspections arc
rl:~uested at the proper limo. that each address is readable
from tile street, lhat the permit card is located at the front
of Ilw property, 3nd th~ approved set of plans will remain
00 the site al "'11lmes during ~~J",U:P~/l
Gi~nalurc ~ ~/ I
/~?
Date
ffil/
I
/
VALIDATION:
RECEIPT NUMBER 8 ::5~"3
~~'T~ "73
DATE PAIr>
AMOUNT RECEIVED --d/. & 2-
RECEivED BY __~~