HomeMy WebLinkAboutPermit Electrical 1999-8-17
225 FIFTH STREET ELECTRICAL PERMIT APPLICATION
SPRINGFIELD, OREGON 97477 I)'
INSPECTION REQUEST: 726-3769 Ci ty Job Number VI C1 0 <t";~-
OFFICE: 726-3759
1. LOCATION OF INSTALLATION
'''k ~ "" <; -<- C ~ _ a. \- - ..s J \ b A.
,
LEGAL DESCRIPTION '
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JOB DESCRIPTION
J 00 \\~ P S;'<'R "'~"-_ \\'\'1","-:;: I')
Permits are non-transferable and expire
if york is not started vi thin 180,days
of issuance or if york is suspended for
180 days,
3. COMPLETE FEE SCHEDULE BELOII
Nev Residential-Single or
Multi-Family per dvelling unit,
Service Included:
Items Cost Sum
1000 sq.ft. or less I S 85,00 t6,-
Each additional 500 J !I. I~ ,-
sq. ft or portion
thereof #) $ 15.00 ~--
Each Manuf'd Home, or
Modular'Dvelling
Service or Feeder .$ 40.00
2. CONTRACTOR INSTALLATION ONLY ,B. Services or Feeders
c I _ Installati?n, Alterations
Electrical Contractor r~ -"..,., ".../ c- J--1'/>,' or Relocatlon:
Address21,j~ 8'-6 ~ '-\,,-r:-c LA""""
Ci ty F /0 ~ _.N~-(
Phone _'> L))_ '\ "ll - 3 6--> \
Supervisor License Number .3?3 } -. '\
Expiration Date
}O-\-O~
C. Temporary Services or Feeders
Installation, Alteration or Relocation
Constr Contr, Number;) 0-3"6 ,-C
Expiration Date
) <;>-\ - '" u
Signature of SUP::~sin~:)lectrician
~(lf -t2L.-r;~
Ovners Name tt. ,,! '" VII J3 L ~ .> ~,.J
Address
') '7 "
)-J~~ 71 NO
Phone 6.J i-S' g 'J 7
Ci ty E-I" .....~-<.
"
O\INER INSTALLATION
The installation is being made on
property I ovn vhich is not intended
for sale, lease or rent,
ovner~ture:
'-.... ... ,=..-...-: ')
---------------------------------------
, '
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DATE:
RECEIPT ~:
RECEIVED BY:
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
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or 10QO voLts
D.
Branch Circuits
$ 50.00
S 60,00
$100.00
$130.00
$300,00
$ 40.00
$ 40.00
$ 55.00
$ 80.00
see "B"
above
.'
Nev, Alteration or Extension Per Panel
Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Additional
Circuit or vith Service
or Feeder Permit
E.
5,
SUBTOTAL OF ABOVE
'l'loSta te Surcharge
31. Administrative Fee
TOTAL
$ 35.00
$ 2,00
40.00
40,00
20,00
36,00
$
$
$
$
~':
.,
<$lLf). -
,-. .
.'
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
_ \\9J\~Cf\ ' PHONE:~'6.~q'L
ADDRESS: , ~m./),C\~ STATE:~IP:~
LOCATION OF PROPOSED ~ILD'J'\G SITE: f'... '
Street Address: t()~J l d 'f--. iM~ . \!J\i 1\. t
Plat Name1\\))~s,1Y\ ~\~Tax ~~ Number: \~t'iJ1)4-II~lLO
1. DEVELOPMENT TYPI; (Check appropriale dwelling(s), sec calculations an~:w~lIing l
ype definitions are on the back.)
.
Job. No. ~Qm4h
-'
NAME:
A. SinQIE\-F8milv Dp.f8~hp.d.
Single Family home
NO. OF UNITS \
\ Manufactured home not ifi a park
X $1,000 per unit = $ ---UXP ~
B. f;inoIA'-F8milv Aft8ChAd
NO. OF UNITS
X $924 per unit = $
C. .Multi-Familv Aoartmp.nt
NO. OF UNITS
X $692 per unit = $
D. .M8nllf.lli<Wred Home Park
NO. OF UNITS
X $699 per unit c $
$_\DOO ,00
rI
$ \DfX) pO
$
WILLAMALANE SDC
2. SDC CREDIT (if appficable) SDC-payer must furnish proof of
WiUamalane Credit approval. See SOC Credit Worksheet.
3. TOTAL WILLAMALANE NET SDC ASSESSED
r (if sec reduced for Credit)
~~e;~,Qartment
City of Springfield
I
I
Date