HomeMy WebLinkAboutPermit Electrical 1996-1-26
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SPRINGFIELD
'~ submtttad has the loll
The following prO\ec as , ~peciflC land U80
zoning, end dOGS not. rsqUlre .
approval, , &/Il;u
ZOOlng tI.../~
225 FIFTH STREET Doto , . d-..& - q ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ~
INSPECTION REQUEST: 726_3M910rlzadSlgnature /' I G1ty Job Number 9~?~
OFFICE: 726-3759
1. LOCATIilli,OF INST~Y'TION
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LEGAL DESCRIPTION
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JOB DE~CRIPTIO~/
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Permits are non-transferable and expire
if york is not started vithin 180 days
of issuance or if ,york is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY B.
Electrical contracto~~~~~~
Address
City
Phone
Supervisor License Number
Expira tion Da te
Constr Contr, Number
Expira t ion Da te
~ Signature of Supervising Electrician
Ovners Name ;t;;7V~ 75' ~~D..
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Address3~73' l?~~~~'
Ci ty e~ <" .r~C Phone ~~'~",e;
~VNER ~NSTAL~
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent,
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RECEIP Iii : '2tt5 1'76 ...-?
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3.. COMPLETE FEE SCHEDULE BELOV
A.. Nev Residential-Single or
Multi-Family per dvelling unit.
Service Included:
Items Cost
Sum
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular'Dvelling
Service or Feeder
$ 85.00
$ 15.00
$ 40.00
Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less '$ 50.00
201 amps to 400 amps $ 60.00
401 600 amps - $100.00
amps to
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
t./d .~
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200 amps' 'or less ......-- $ 40.00
201 amps to 400 amps $ 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
$ 35.00
$ 2.00
E..
Miscellaneous (Service/feeder
-Each installation'
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
not included)
--
$ 40.00
$ 40.00
$ 20.00 ~.~
$ 36.00
6 CJ, c::rc:>
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5.
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
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Job. No.
C\~\tfY\
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, SYSTEM DEVELOPMENT CHARGE
WORK~HEET ' ,
NAME: \\tiroo\1~W,'N' ~HO'NE: 4~c;, '6\1\..0_
ADDRESS: 3ffi') \<.\\\OX ~e)\~\L. S STATE:~' ZIP: q~
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LOCATION OF PROPOSED BUILDING SITE:
Street Address: Jl? ~ ~\\~J ~\'d \ \~"(h\
Plat Name: \\>\)~( (1\~(\ ., Tax Lot Number. \1bll)
tG3
1. DEVELOPMENT TYPF (Check appropriate dwelling(s). SDC calculations and d elling t
ype definitions are on the back.)
A. Sinale-Familv DetFlched
~ Single Family home
, NO. OF UNITS
Manufactured home not in a park
l X $1,000 per unit = $ lOaD ,CX)
B. Sinale-FFlmilv Attacheq
NO. OF UNITS
X $924 per unit = $
C. Multi-Familv Aoartment
NO. OF UNITS
X $692 per unit = $
D. Manuf.agllrp.o Homp. P~rk
$
$
\ ()oD ,00
,0
NO. OF UNITS
WILLAMALANE SDC
X $699 per 'unit =
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willamalane Credit approval. See SDC Credit Worksheet. $
3. TOTAL WILLAMALANE NET SDC ASSESSED
. . (..~C _00' ~""tJ
~I '~.~- ~l- I
Deve opme\J ~e es Department Date
City of Springfiel
$ \N1'\00
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