HomeMy WebLinkAboutPermit Electrical 1996-8-23
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225 FIFTH STREET
SPRINGFIELD, OREGON
INSPECTION REQUEST:
OFFICE: 726-3759
Zoning L..:~ _
Dot. ~/l?-_)'crl..p
974 rrclhorlzed Signature
726-3769
1. ~~~ OF INSTAH.ATION
Q1...4 ___ ~\:"l\')09.U'\r'l\\ \U~
\~r.r5~&~~ON~ ()\m~
0" :J.QI}.,.DES~PTION -r" ~8'
.:---.'-- 'Co Nr\ n II\~ ,C\ \dl ~
Permits are non-transferable and expire
if ~ork is not started ~ithin 180 days
of issuance or if ~ork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY ,B.
Electrical contract~tJ~:l\X\~~~
Address \~() '<.\ffi~'\'u'n~
City_T t~n<L _ ~one\O~~,-1h3
Supervisor LIcense Number '?JC\~~
\(). \. C\'l
C\\Ml\~
\, ~'Q .c\r")
Expiration Date
Constr Contr, Number
Expiration Date
Sign~:;U::;;trician
O~ners Name~d\1 AD f)~Cf(\OO
Address3~ t>1\")Qf.,,~ t\"lcL
Ci ty €A )('tOj('() _ Phone ~ '~\'lb
OIINER INKALLATION
The installation is being made on
property I o~n ~hich is not intended
for sale. lease or rent.
Ovners Signature:
DATE~----~~~;z~4rC:-------------------
""'''l:..ll'T 11: ~ ':J. <fro Pi
RECEIVED BY: iv
7M
ELECTRICAL PERMIT APPLICATION
City Job Number q In \ I~ 4
3. COMPLETE FEE SCHEDULE BELO~
A. Ne~ Residential-Single or
Multi-Family per d~elling uni t. r'
Service Included:
Items Cost Sum
1000 sq.ft. or less \ $ 85.00 ~
Each additional 500
sq. ft or portion ~ ~
thereof S 15.00
Each Manuf'd Home, or
Modular'D~elling
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
C.
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
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
D.
Branch Circui ts
$ 40.00
$ 55.00
$ 80.00
see "B"
<to
above
Ne~, Alteration or Extension Per Panel
.'
One Circuit
Each Additional
Circuit or ~ith Service
or Feeder Permi t
E.
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res -----
Limited Energy/Comm
5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$ 35..00
$ 2.00
not included)
$ 40,00
$ 40.00
$ 20.00
$ 36.00
~.~
S.. i lJ
, ~-:J f_n
.
.
Job. No.
Q{P1J94
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NA~E: 'tldwL ~cNnmo1\ PHONE: 4~~'d\')( I?_J
ADDRESS:OSC\6 ~\')Q(~STAi-E:~ZIP: Lt-MK"
LOCATION OF PROPOSED B~DING SITE:
q'2..t..J . ~/', \ f!J rfJJ /J, "'I^. I )
Street Address: ~ IJt. '.nDf.J...............(,) JHLV
Plat Nam~O,x- G\pYl Tax Lot Number: (} \1\ 1\~?3DO
" L 0 QQ0
1. DEVELOPMENT TYPE (Check appropriate dwelling(s). SDC calculations a~~Wel~ng t
ype definitions are on the back.)
A. f)in(lIA-FRmilv DAtRchAO
l Single Family home
NO. OF UNITS l
Manufactured home not in a park
X $1,000 per unit = $ \.\:30D,oO
B.. Sinale-Familv AttRchAO
NO.. OF UNITS
X $924 per unit = $
C. Multi-Familv ADartment
NO. OF UNITS
X $692 per unit = $
D. Manufactured HomA Pm1~
NO. OF UNITS
WILlAMALANE SDC
X $699 per unit = $
$ ~OOO .00
f)
$
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credit approval. See SDC Credit Worksheet.
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
~\~'fJ~ % I
Development Se~lfes Department Date
City of Springfield
$ \Dr1O.o0
~ I q,~
1