HomeMy WebLinkAboutPermit Electrical 1995-3-6 (2)
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"The following project a9 suqmitted. ~a:; the bll?'Nlng
zoning, and does not require specifIc lUrid use
approval.
225 FIFTH STREET Zonina
SPRINGFIELD, OREGON 97~77
INSPECTION REQUEST: 7~~!)'07
OFFICE: 726-3759 Authorized Signature.
1. LOCATION OF ,AlSTALLATION
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LEGAL DE~PTION
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~JOB DESCRIPTION ~
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ELECTRICAL PERMIT APPLICATION
Ci ty Job Number 9~ ~
COMPLETE FEE SCHEDULE BELOV
3.
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days,
It ems Cos t
Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. f t or portion
thereof $ 15,00
Each Manuf'd Home. or
Modular Dwelling
Service or Feeder $ 40,00
~ CONTRACTOR INSTAL~ON ONL~ . .B. Services or Feeders
~.....,.... /?f..VEll'J~/r.-- ~~~nstallation, Alterations
Eleet!'is...l-Contractor~ . . or Relocation:
Address 200 amps or less
201 amps to 400 amps
City Phone 401 amps to 600 amps
601 amps to,lOOO amps
Supervisor License Number Over 1000 amps/volts
Reconnect Only
Expiration Date
Constr Contr. Number..09 t,.I'3"?-2.
Expiration Date
.
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Signature .of Supervising Electrician
Owners Name8/.v.:g' ~~n ~~ ~D.
Address ~70 79~-~~ --'.:F:,
. 7~7'~/..? '2....
Ci ty<?1~~~t. Phone "7.if7~
OlINER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
;wn~~
DATE~------~:<f~~~----------------
RECEIPT II: /tf.7"..2/
RECEIVED BY: /' .A6~v_
$ 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
Branch Circuits
----
$ 40.00
$ 55.00
$ 80.00
see nB"
~~
I
volts
above
.'
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
no t included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
SignlOutline Lighting
Limited EnergylRes
Limited Energy/Comm
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 40,00 .'
$ 40.00
$ 20.00
$ 36.00
Ut? _ .se::>
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=_ SPRINGFIELD .-
~~~~I~Nl~~t;CATION ~ JOB NUMBER
Inspections: 726.3769 ..~ 225 Filth Street
Office: 726.3759 ~JI Springfield, Oregon 97477
LOCATION OF PROPOSEp~ORK:. 4C\\ ol () ~~<; c;..' T~/.# .~: '
ASSESSORS MAP'\~f'f)[Wy} TAX u:i-r. U.JQ Fr) .
~ BLOCK' SUBDIVISION: ,,7i'r:~ ~~ ,..-'___
LOT' .
~
OWNER' I?/"? ,/~t'/t::.~A/
ADDR~""" '2.'&6 ,1/ /~~"5z73'
CITY' &~~t:E' . ." STAT~' .
O'??
]>~0?328
PHONE:
6~'3 ~S 7""5-7
ZIP'
~?'7"'~<.
DESCRIBE WORK' /;y:.~<:.. ~;or;'~ ?:'-1"1."/,7"~~.r,,- ~~~-'.Zd> ~;r:s--
NEW REMODEL ADDITION'" DEMOLIsH OTHER ~ ~,c
To request an Inspection, you must call 126,3769, This Is 824 hour recording. All Inspections requested belore 7:00 a.m, will be
made the same working day, Inspections requested aUer 7:00 a.m, will be made Ihe following work day.
REQUiRED INSPECTIONS
D Rough Mech~nl~al ..: Prior to
cover. .
D Temporary Elec~~lc
D Site Inspection - To be made
atler excavatlon, but prior to
setllng forms.
D Underslab Plumblng/Eleclrlcal/
Mechanical - Prior to cover.
D Footing - After trenches are
excavated.
D Masonry - Steel location, bond
,beams, grouting.
D Foundation - Alter forms are
erecled.but prior to'concrete
placement.
D Underground Plumbing - Prior
10 flfllng Irench.
D Underfloor Plumbing/Mechanical
- Prior to Insulation or decking.
D Poat.and B~am.- prl~r to floor
'Insulatlon o~ decking. ..
D Floor Insulation - Prior to
decking, .
ri/I Sanitary Sewer - Prior to filling
\Ao-J trench,
r71 Storm. Sewer - Prior to liMing
\.4-l Irench. .
.. r.71 Water Line - Prior to filling
. t.+-J trench,
D Rough Plumbing - Prior to
cover.
D Roug-ti .Electrlcal -:- PrIor' to
. cover. , .
D Electrical Service - Must be
approved to obtaln.,permanent
electrical power. :,- ....;;:#_
.'
D Fireplace - Prior 10 facing
malerlals and Iramlng Insp.
D Framing - Prior to cover.
D Wail/Coning Insulallon - Prior to
cover.
D Drywall .,... Prl.or 10 taping.
D Wood Stove - Aller Installation,
D Inserl - Aller IIreplace approvol
and Installallon of unit.
DCurbcut & Approach - After
forms are erected but prior to
placement of concral.a.
D Sldewatk & Driveway - After
,excavation Is completo, forms
.and 'sub.base. material In place.
D F~n~e - When completed.
D .Street Trees - When all required
trees are planted.
D Final Plumbing - When all
.plumblng W9rk Is complete.
D Final Electrical - When all
electrical work Is complete,
D Final Mechanical - When all
~echanlcal work Is complete.
D Final Building - When all
required Inspections have been
approved and building Is
completed,
D Olh~r .
MOBILE HOME. INSPECTIONS
D BI~ckln'g and Set.Up - When all
blocking Is complete, . .
D Plumbing Connections - When
home has been connected to
water and sewer.
D Eleclrlcal Connection - When
blocking, sel.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
. D Final -' Aller all required
Inspections are approved and
porchos, sklrthig,decks, and
venting have been Installed.
. t, :t
Lot faces
Lot Type .
Interior
Lot sq. ltg,
Lot coverage
Corner
Topography
Total height
Panhandle
Cul.de.sac
BUILDING PERMIT
ITEM SO. FT.
X $/SO. FT. a
Main
,
Garage
Carport
Total Value
BUilding Permit Fee
State Surcharge
Total Fee
(A)
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanllary Sewer FT. ~"'3
Water FT. ~'3
Storm Sewer FT. ~3
Mobile Home
Plumbing Permit
State Surcharge
Total Charge
(C)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Vent Fan
N'
Wood Stove/lnsertlFlreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State Surcharge
Total Permit
(D)
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, 0, and E Combined)
?: -' ~ '.
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Setbacks .
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.,
(. THE PROPOSED WORK IN THE,
,RISTORICAL DISTRICT, OR ON
THE HISroRICAL REGISTER?
If yes, thla application must be algned
and approved by the Hlatorlcal
Coordinator prior to permit Issuance,
"
I P.L. HSE GAR ACC I
N
's
Iw
IE
VALUE
"
.....-,~...
I APPROVED'
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 suapended or revoked at any time
upon violation of any provisions of aald ordlnancea.
Plan Check Fee:
Date Paid:
Receipt Number:
Received By: .
Plans Reviewed By
Date
Systems Development Charge Is due on all undeveloped
properties within the City limits which are being Improved,
,< ADDITIONAL COMMENTS
FEE
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q/7
/'20, "'C
6. PI!!>
:; €6-
/2 9,60
By slgnature,l state and agree, that I have carefully examined
the completed appllcallon and do hereby certl fy that all
Informallon hereon Is true and correct, and I further cerllfy
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 further agree to ensure that all required Inspectlons are
requested at the proper time; that each address Is readabla
from the atreet, that the permit card Is located at the front
of the property, and the approved set of plans will remain
on the sit t all limes during co trucllon,
SI~r
DateV~:5'~
VALIDATION:
RECEIPT NUMBER
/ ''2, / ;;-.:1
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I?S C;,0
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DATE PAin,
AMOUNT RECEIVED
RECEIVED BY