HomeMy WebLinkAboutPermit Electrical 1999-12-9
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The. following projecl as submitted has the fOllowing
zomng, and does not require specific land use
225 FIFTH STREET approvaL
SPRINGFIELD, OREGON 97477 Zoning LD y(.-
INSPECTION REQUEST: 1X.1ir17/;Q n-c,-I'?ct'i
OFFICE: 726-3759 ., \
Authorized Signature c:x..w ")
1. LOCATION OF INSTALLATION
'''R~<Ac..-<. C"'-'~"'\- ....s,'-\<J
ELECTRICAL PERMIT APPLICATION
910~1-4
City Job NUmber
("OHPI.RTE FEE SCHEDULE BELOI/
,
A. New Residential-Single or
Multi-Family per dwelling unit.
Service Included:
LEGAL DESCRIPTION
" \.., v, 0(< .." t ,"",,--J H -, J y '"" l .;:, -\- 3
JOB DESCRIPTION
J 00 C\"'" p .s.'~'R ,)~c:..,. 'I""",~))
Permits are non-transferable and expire
if work is not started within 180,days
of issuance or if work is suspended for
180 days.
Items Cost
Sum
1000.sq.ft. or less S 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home. or
Modular. 'Dwelling
Service or Feeder '2-, $ 40.00 go
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
2. CONTRACTOR INSTALLATION ONLY .B. Services or Feeders
. 1._ Installati~n, Alterations
Electrical Contractor r~ - ~ "'" (\A C )--1-;>, 'or Relocatlon:
Constr Contr. Number;) D-3L/c., ,-C
Expiration Date
I c- \-<;;:,-;)
Address 2 \] c) ;3 'i ~ '-\ -5 t:- c l.- A ...J -<:
City FJO~_N~-<
PhoneSCI)- '1"'li-36.s-1
Supervi.sor License Number .3 r"/.3 J - _ '\
Expiration Date
\O-\-C~
,Signature of supe~~ectrician
4>~l( '/~E~~.-J
Owners Name l~.'l'" W 13 c.. ,.;' ~ ...J
Address
City E-t
1'7"
).J ...... ~
"11 NO
(,!fi-'gg?7
'1 't"'~.....-(.
Phone
OI/NER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
ovner~~ure:
" ~)
DATE~---------~~-;-$'::~;r-~---------
RECEIPT ~:7~ 1 ~ ":>
RECEIVED BY: - -4-7l'~
$ 50.00
,$ 60.00
$100.00
$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 10~0 volts
D.
Branch Circuits
$ 40.00
$ 55.00
$ 80.00
see "B" above
0'
New, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Limited Energy/Res
Limited Energy/Comm
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit ?
E.
5,
SUBTOTAL OF ABOVE
'l'loSta te Surcharge.
37. Administrative Fee
TOTAL
$ 35.00
$ 2.00 :i-
not included)
$ 40.00
$ 40.00
$ 20.00
$ 36.00
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'7.,'1"-
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.
.
Job. No. Qq~~~J
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
NAME:~.~~ . PHONE:~~<6.~~1
ADDRESS: ()Af) \~(a:\ ~STATE:~ZIP:~
LOCATION OF PROPO~~DlNG SITE: .
Street Address: nf\AJ) ~ j$~ ~ 00 Jtt-
Pial Namelfi.\15\~D ~~Tax Lol Number: RmM \ \ ~tD
1. ,DEVELOPMENT TYPI; (Check appropriate dwelling(s). SDC calculations and dwelling t
ype definitions are on the back.)
A. SinnlA-FRmilv DelRched,
Single Family home
\ Manufactured home not in a park
t X $1,000 per unit = $lDOlJ .or;
NO. OF UNITS
8. .8innIA'-FRmilv AttRchAQ
NO. OF UNITS
X $924 per unit = $
C. Multi-Familv Aoartment
NO. OF UNITS
X $692 per unit = $
D. ManufRcfllrAn HomA PI3Ik
NO. OF UNITS
WILLAMALANE SDC
X $699 pef unit = $
$ \[)rl) pO
[1
$ \t'N) (X)
2. SDC CREDIT (If applicable) SDC-payer must ful1'ish proof of
Willamalane Credit approval See SOO Credit Worksheet. $
3. TOTAL WlLLAMALANE NET SDC ASSESSED
(If SDC reduced for Credit)
~)l~~
Development se~s- Department
City of Springfield
. 121
Date
9
I 95'