HomeMy WebLinkAboutPermit Electrical 1995-8-7
Tho. following project as ....bmnted has tho. following
lcnlllg. and doe~ not require specific land use
approval.
Zonino L,T).(?_
225 FIFTH STREET D~o ~'7-~
SPRINGFIELD, OREGON 97477 '
INSPECTION REQUEST: 7 ~.b:l?iS'9 SIgnature
OFFICE: 726-3759 '
~
1. LOCATION OF INST~TION ~
~'2-BO;- ':::;ovn+ l-&bwnob \ J/C..
LEGAL DESCRIP~ION
1...0,04-- I K /J 'U)~ I a
JOB DESCRIPTION
AI S'FK
Per~its are non-transferable and expire
if vork is not started vithin 180 days
of issuance or if vork is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY
Electrical Contractor
.4b-81J ;l$ud.co
3~ 5/7
Address / .2
...,.vU
Ci ty k.~k!.4<; Phone.LJ /, \- - ..J.. / } '7
Supervisor License Number /<f) a:>/-: S
Expiration Date /0 -/ '- 7,t;""'
Constr Contr. Number tb$ 7~0
Expiration Date '7 - LJ -9 ,-
Signature of SU~Sing Electrician
O@-""f/t.-\ .--- ..r ../~.,/L..___
-, - .)
D.
Ovners Name J/~7>AA.J Fd (~c_
'fJ'j t 5,"5 :l'd -s;'/-,
City <'OF-l:~:)) Ph~ne ~J-JiI-b9d.C
I
Address
OVNER INSTALLATION
The installation is being made on E..
property I ovn vhich is not intended
for sale, lease or rent,
Ovners Signature:
;~~~~-------~~-:CJ(S;-~-------~~---~ 5.
RECEIPT #: . I '-,..--.w;_L:.6.-I~
RECEIVED BY: t"l\\.It\U .
ELECTRICAL PERMIT APPLICATION
r'..,. Job Number
q6lJ"1~
3.. COMPLETE FEE SCHEDULE BELOY
A. Nev Residential-Single or
Multi-Family per dvelling uni t.
Service Included:
Items Cost Sum
1000 sq.ft. or less $, B5.00 ~ 6: (}7)
Each additional 500
sq. ft or portion t- ~tJ. tJ3
thereof $ 15.00
Each Manuf'd Home. or
Modular Dvelling
Service or Feeder $ 40.00
,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
$ 50.00
$ 60.00
S100.00
$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
$ 80.00
see "Bit above
Branch Circuits
"
Nev, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
$ 35.00
$ 2.00
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
no t included)
SUBTOTAL OF ABOVE
5% State Surcharge
3% Administrative Fee
TOTAL
$
$
$
$
n 6-171>
J? 77
~.i.{~
l~t/~
40.00
40.00
20.00
36.00
.
e
. I
.
'l'" ~ ..
o !!)!in~m~g!!.~
."
'.
Job No. CJC;()1~
SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
NAM~ *~d(fL, ~.P V1~S
ADDRESS: ~ ~q 0D . 1J)1}1---~ w./fJ
PHONE: Jlfl/v (Pj &&
STATE:.M:. ZIP' Cf1lf71
'.
. - '
. .....-_..
Platt ~ame: I ~ D 'V 6 (p t'l---
Tax Lot Number:
fU.dj))tiJrf- . W,V-t '
1A~(fl) .
Lq<:ATION OF PROPOSED BUILDING SITE: /' /, . /,''''
Street Address if Known: . ?JVI'o VJmJ'kYI.
1. PEVElOPMENTTVPE (Check appropriate dwellirig(s). SDC calculations and dwelling type
definitions are on the back.l ' , ' " , ,',', '
A. 'Sinl'!ie Familv - Oetached
t, Single Fa~i1y home
. NO OF UNITS
Manufactured home not in a park". ,I"" '
X $400 PER UNIT oF. $" l.f.(l) .IJ/J
B. Sini!le Familv .'Attached
.'
..\
NO OF UNITS
X $370 PER UNIT =
. $
~, Multi-Familv Aoartment, .
NO OF UNITS
X$?-77 PER UN,IT =
$
D. ManufactUred Home Park
NO OF UNITS
X $280 PER UNIT = ' $
WPRD SDC
.: .
. $ IMIJ . {)fJ.
2. SDC CREDIT (If applicable> SDC-payer must fumish proof ofWPRD Credit
approval. See SDC Credit Worksheet. " , $
OTAl WPRD NET SDC ASSESSED (If SDC reduced (or Credit) $ l/bO ,ffl)'
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