HomeMy WebLinkAboutPermit Electrical 1996-1-9
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The following project as sUbmtttod, has Ih.. 10 0 \,,'Pi~, 6'\':,
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225 FIFTH STREET ", Date /.-:- '1 -1 ~ /"l.ll ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 ..(\"h izoO Slgnalure. ~ / nt::::\OO I (J
INSPECTION REQUEST: 726_3/69or 1 City Job Number X1~~,
OFFICt{~-3~: If y V'7V ,. 3..
~'?R. tJ~~~~~t't- '
~ -lD3 i~ciSION 0\000
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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
Electrical Contractor BOB FISHER
Address 1 RO KTI\lr,SRfTRY l1YENlW
Ci ty t;-TTr.!'R-:\Tl4'
Phone fiR9- 7..9.,73
Supervisor License Number ~7~~
Expiration Date In_'_OQ
COMPLETE FEE SCHEDULE BELOV
Ne~ Residential-Single or
Multi-Family per dvelling
Service Included:
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manuf'd Home, or
Modular 'Dvelling
Service or Feeder
B. 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
It ems
\
""3
unit.
Cost
Sum
<&S
%
S 85.00
S 15.00
S 40.00
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
Constr Contr. Number 96275
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Expiration Date
'_7"'_01';
Signature of Supervisin~ Electrician
Y-- ~P:J-.J~
Ovners Name ~ ~l l..<L.. ~ ~
Address ?->C;C\~ ~\\l.\ (" ~n\~
City l.t'Ot1\P- Phone <\~~.5\'\lO
OVNER IN~TALLATION
The installation is being made on E.
property I ovn vhich is not intended
for sale, lease or rent.
Ovners Signature:
,
~~~E~-~----------~a~qC---"f~ 5.
RECEIPT~: ~) ~
200 amps' 'OT less V- S 40.00 ~.t). 00
201 amps to 400 amps S 55.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see "B" above
D.
Branch Circuits
Nev, Alteration or Extension Per Panel
One Circuit
Each Addi t ional
Circuit or vith Service
or Feeder Permit
S 35.00
S 2.00
not included)
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
40.00
40..00
20,00
36.00
S
$
$
$
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/70.40
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Job. No.
q~\~~lP
, SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME: ~'\llJO_ PJ ~f\; PHONE: L\t~.~\lLP
ADDRESS:~~~ \{\\\~mo-, STATE: tW.:-ZIP: 4l4D'3
LOCATION OF PROPOSED BUILDING SITE: 8m €i~~
5tceet Add''n~ ~ \CO.!J\l.-J. ~\ciot - \Jfc
Plat Name: ~\\lW (;lOJf\ " Tax Lot Number: \1fl~'1.~
1. DEVELPPMENT TYPJ::, (Check appropriate dwelling(s), SDC calculations and dwelling t
ype definitions are on the back.)
.
A. ~inf)IA-F::Jmilv DAt::Jr.hAn
\ Single Family home
, NO, OF UNITS '(
Manufactured home not in a park
X $1,000 per unit = $ \ tim, CD
B. SinQle-F"milv AtI::Jr.hAQ
NO. OF UNITS
X $924 per unit' = $
C, Multi-Familv ADartment
NO. OF UNITS
X $692 per unit = $
D. fv1::JnlJf::JctlJrAn HomA P::Jrk
NO. OF UNITS
WILLAMALANE SDC
2. SDC CREDIT (if applicable) SDC-payer must furnish proof of
Willarnalane Credit approval. See SDC Credit Worksheet.
$
3. TOTAL WILLAMALANE NET SDC ASSESSED
(if SDC reduced for Credit)
~~~~~~~~~ment
City of Springfield