HomeMy WebLinkAboutPermit Electrical 2004-7-8
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225 FIFTH STREET . SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 ,'_ " ;:~. :d", -..11';';':;'
ELECTRICAL PERMIT APPLICATION" ....~'O. of ~i '." qj
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City Job Number COmwoL/ _ OCJ7ob Date ' ~Q'ci\~(\o"
"',(\ />00
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3 I' 'COMpo' """''E'~PfriED ' E' ,,;;,..~ ,,"'0'0.,..'.<..:....::
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~~'".l<:..J;..::."l:.UJ,;t'~; 'l..t:~l'~O "'R~6-.1 ~.to('i .~...."b..,. ..LoI~,1....cr' .....v~t.~.:i:..~.~....::c,~
. ." . . '3-9 . ,.... ~'(0
A. ~~~~~~.R~~ia~'~i.Gl ~,(~ig;i1.~.:.~-lM~~.~~1IY~;2?d~v~~li'iri~.~Wft~~;';.~~:
. f ~..:....:....... ,:,...;.1.... ..j.~,........<.l.:.~4a ~~(,..0.'__.:ii\,4r...t.;.. .~.'. .l,:....~. :....',J),. ,..,.,.'1.,....:1.....,.........::,
Service Included ,,,\'"
\;:; le.c...t-\\ ( 200 Amps or less $ 63,00
. 201 AmPsto1W~W $75.00
,IO(2) Au-~~~:OI~~~\e~98~~~~ $125,00
--f.\ ,.... adO~Jo'~la~a:RiiS~..oo'O $163.00
Phone 13~~'9'~cen\anv;Q'tO~ ~yU\S$tlll $375.00
~O\i'\C"~;'2...oo1.on\Q.ID1c~ U\$ _knftO $ 50.00
~O"'P.9 a'lotl~CO .~a~\~Y'-::~,
4l '-, 4 - 090. '(oU '" .!-, ~~.fiAtl'~~~Nh~deiS:.~~~,;~; ~. '/'%-~!';'."'W~" ~~,.,l~~
( ca\;".g\l'le~b-i~:~~~""""" .. '-~ ,?\""<1i' ..,,'.' ,
[) I .. [) 4 (lU"',oel~~~\efnlt~~~~~teration or Relocation .
200 Amps or less I
20 I Amps to 400 Amps
401 Ampsto 600 Amps.
Over 600 Amps or 1000 Volts see "B" above.
D, ~B~~~il~lfcl~~ctit~~it~:[:",~~~~1i~~,~1fEJ;~~::,:~~~:.~J..~:) v'";,' ',~..;:~Z~'~l
~x....::.~~-:;."':;IOi..~.."" .~, '. .i~'l.4~~"" ... :o.....".~~...~';!.."
,p,-..,'1!t''''_1.....;;':;:O.'";'" ~"l""~ "'~";;:>:~.~ 7'':''''~''''''''- o.,:~-:.;;-,;r'R
L riLOCATION OEINSTALLATION ,~~?i:""";fl
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LfOZO S, l2Fd-Jood .
LEGAL DESCRIPTION
1<60 ~ ob (I
10000
JOB DESCRIPTION
i T6-wrf
N"l-l
(l.es
f
Permits are non-transferable and expire if work is
not started within 180 days of issuance or if work is
Suspended for 180 days. '
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"CONTRACTOR INSTALIATION;ONLY,,:
2, \:::JlU~:t,)J.t;)~'f7',9",j,~<;".-::--.i.~oJ;ic::~..e:~'.Jl-.."r,,,,,,,:'ik ...-"t.""~
Electrical Contractor L €. E
Address q (). 6 :3 3
City
Sr~ld
Supervisor License Number
Expiration Date
10
Expiration Date
1051.-1'15
'So. 30 -nlo
Constr. Contr. Number
Signature of Supervising Electrician
FoQ D~D~
LA, t:e--L.trfl-' J-
WI a ~ If-.] Ii'
Phone b'i?b' 71( )X'
Owners Name '"1S (""c..e:::'
?~7r
Address .:> ... J
City I- <1,.Lc' -t7I/ ti-
OWNER INSTALLATION
The installation is being made on property I own which
'is not intended for sale, lease or rent.
Owners Signature:
Inspection Request: 726-3769
1000 sq. ft. or less
Each additional 500 sq. ft. or
portion thereof
Each Manufact'd Home or
Modular Dwelling Service or
Feeder
I
2.
lob
3.y
$106.00
$ 19.00
$50.00
~;"j;'r'l."T:'."'i';{;:.<' "':~:-:;;:E.~-::;ry.~"'m;.'f;...,...,~~,::;~ q,~~"~'i(';n~7.';:~c"\fil:.''-'''''''':',1
B. fServices'orjFeei:lers~Jnstallation/Alte'ratioi1s 'or Relocation:';r;;';~
G~L!:S--,,::'d~.:~..:.;s:..1}'~~~~" ~...' ,'.' ,~~...~_......."J~~.~,;:s,;:.J
$ 50.00
,$ 69,00
$100,00
so
New Aiteration or Extension Per Panel
One Circuit
, Each Additional Circuit or with
N OI'fC'ff or Feeder Pennit
~~:!:!~t=~!to~~~~,'~'J
ANY sig.odi.llfuPEliIOOg , $ 50.00'
Limited Energy/Residential $ 25.00
Limited EnergylCommercial $ 45.00
$ 43.00
$ 3.00
Minimum Electric Permit Inspection Fee is $45.00 + Surcharges
"';~4:".~"''''\r.;~:rl,-:,~T;I-:~.,~f''~''~'~''~'~'' .:'\'... r'~~i'\:'~
4. "SUBTOtALO'F'iwOV:Ei,' 'i'; ,',c6Y!,<~.
1~:!_;:r:::':'l_~.;;.."t?if'..~o::"_.t~",..lC_:~~'~t''':.'' d;,; :.;'
I~Lf
/-;,.58
/ '14D
2-z..b~
7% State Surcharge
10% Administrative Fee
TOTAL
Shared Drive{T:YBuilding Fonns/Electricl1l pennit Application 1.Q3.doc
= S214.23 11055
SO.OO 1054
SIO,OO 1056
$538.86 J
$3,107,60 ]
CHARGE I
S155.38
.. .' .
CITY OF SPRINGFIELD SYSTEMS DEVELOPMEN&RKSHEET
JOURNAL OR JOB NUMBER: COM2004,00706
NAME OR COMPANY: Custom Homes
LOCATION: 4020 S Redwood Drive
TAX LOT NUMBER: 18020611 Tax Lot 10000
DEVELOPMENT TYPE: SINGLE F AMIL Y RESIDENCE
NEW DWELLING UNITS I BUILDING SIZE (SF' 1872 LOT SIZE (SF):
I. STORM DRAINAGE;
DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUS S.F, x I COST PER S,F. 1 CHARGE
3032.50 I $0.290 = I $879.43 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUS S.F. I x I COST PER S,F. 1 x I DISCOUNT RATE I I DISCOUNT
I 0.00 I $0.290 I 50% I I $0.00
ITEM I TOTAL, STORM DRAINAGE SDC
$879.43
2, SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU
I 20 I $22.64
B. IMPROVEMENT COST:
I NUMBER OF DFU's I x COST PER DFU
I 20 $17.21
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = ,
3 TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I
I 9,57 I I I
B. IMPROVEMENT COST:
I ADTTRlPRATE 1 x I NUMBER OF UNITS I
I 9.57 I I
ITEM 3 TOTAL, TRANSPORT A nON SDC
S797,00
x I COST PER TRIP
I $17.23
x I COST PER TRIP
I $76.01
= , $892.31
x INEW TRIP FACTORI
I 1.00
x INEW TRIP FACTORI
I 1.00
4, SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I I I I $314.63
B. IMPROVEMENT COST:
INUMBER OF FEU's I x
I I I
ICOST PER FEU
I $214.23
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
MWMC ADMINISTRATIVE FEE
ITEM 4 TOTAL - MWMC SANITARY SEWER So( = ,
= ,
SUBTOTAL (ADD ITEMS 1,2,3, & 4)
5. ADMINISTRATIVI' I'I'~
I SUBTOTAL I x I ADM, FEE RATE 1=
I $3,107.60 I 5%
TOTAL SANITARY ADMINISTRATION FEE:
TOTAL TRANSPORTATION ADMINISTRATION FEE:
Matt Stouder
6/18/2004
TOTAL SDC CHARGES
PREPARED BY
DATE
1'-
[/)
"-l
o
o
u
~
5845 !::
J[/)
10
~
$879.43
1070
!
$452,80
1091
$344.20
1092
SI64,89
1093
S727,42
I 1094
I
=
$314.63
11054
, 101.41 1079
I $53.97 J 1078
= , , $3,2,62~9~ ,I
.
.
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS
(NOTE: FOR REMODELS. CALCULATE ON!. Y THE NET ADDITIONAL FIX11JRES)
NO, OF FIXTURES
FIXTURE TYPE NEW OLD
IBATHTUB 1 0
IDRINKING FOUNTAIN 0 0
IFLOOR DRAIN 0 0
IINTERCEPTORS FOR GREASE 1 OIL 1 SOLIDS 1 ETe. 0 0
I INTERCEPTORS FOR SAND 1 AUTO WASH 1 ETe. 0 0
I LAUNDRY TUB 0 0
ICLOTHESWASHER 1 MOP SINK 1 0
ICLOTHESWASHER - 3 OR MORE (EA) 0 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 _; 0
I RECEPTOR FOR REFRIG 1 WATER STATION 1 ETe. ,,0 0
IRECEPTOR FOR COM. SINK 1 DlSHWASHERd ET.C. ".~".. 0 ", 0
ISHOWER. SINGLE STALL ..,," ,."., Vi t. ." ' 1 ',' 0
ISHOWER.GANG (NUMBER OF HEADS) \"<-""l:>;;t:. ""0"'" 'Ii ..0'
I SINK: COMMERCiAURESIDENTIAL KITCHEN'.""', '. '''..,1 .' ',,,, 0
I SINK: COMMERCIAL BAR '11 ...." "- :,'0 . 0,
ISINK: WASH BASINIDOUBLE LAVATORY . ",1. 0.'..
ISINK:SINGLELAVATORYIRESIDENTIALBAR ....'~,..,:.' ,1 ',I '0
IURlNAL, STALL! WALL O' ~'I "k '.' 0,
ITOILET, PUBLIC INSTALLATION 0 I 0
ITOILET, PRIVATE INSTALLATION 2 i 0
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
TOTAL DRAINAGE FIXTURE UNITS
UNIT
EOUIV ALENT
3
1
3
3
6
2
3
6
12
1
3
'- 2
2
3
2;1
2
. 1
5
6
3
DRAINAGE
FIXTURE
UNITS
3
o
o
o
o
o
3
o
o
o
o
2
o
3
o
2
1
o
o
6
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
=
20
=
o
20
.EDU (Equivalent DwellioR, Unit) is a disc~ equivalent to a sinlde familv dwellioR. unit (20 DFlJs) set at 167 ~Ions per day
MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
'j YEAR CREDIT RATE/$I,OOO
ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT'! 2
I BEFORE 1979 $5.04 (Enter I for Yes, 2 for No)
I 1979 $5,04 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 2
I 1980 $4.95 (Enler I for Yes, 2 for No)
I 1981 $4,88 BASE YEAR 1979
1982 $4,75
1983 $4.58 CREDIT FOR LAND (IF APPLICABLE)
1984 $4.41 VALUE/IOOO CREDIT RATE
1985 $4.20 $0.00 x $5.04 =, $0.00
1986 $3.88
1987 $3.50 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
1988 $3.07 VALliE 11000 CREDIT RATE
1989 $2.60 $0.00 x $5.04 ~ , 0
1990 $2.14
1991 $1.71
1992 $1.52 TOTAL MWMC CREDIT = $0.00
1993 $1.38
1994 $1.19
1995 $1.03
1996 $0.87
1997 $0.68
1998 $0,46
1999 $0.27
2000 $0.09
2001 $0,04