HomeMy WebLinkAboutPermit Electrical 2004-4-22
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-.C L ':-: .' EL.CAL PERMIT APPLICATION
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~ Date , ~Hl \1-.'<111111.' ,H.:r uwdling unit.
\mfrma(Y) Authorized Signature Items Cost Sun)
225 FIFTH STREET
SPRlNGFIELD, OREGON 97477'
INSPECTION REQUEST: 726.376Q
OFFICE: 726.3759 , . :.
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Permits are non.transfera Ie nd e.'pl e
if work is not started withil 0 days
of issuance or if work is suspended for
180 days.
1000 sq.ft. or less
Each additional 500
sq. ft or portion
thereof
Each Manufd Home or
Modular Dwelling
Service or Feeder
$106.00
$ 19.00
$ 50.00
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2. CONTRACTOR INSTALLATION ONLY B, Services 01' Feeders
\,c~ . . Installa~ion, Alterations. or..'
Electrical Contractor [\I e,y!'by Ekdr iw ..lltrf1<-e Relocatllln: ,'" ,
AddrcssP.M.E'/J2' (..,5\;,)-1 D.v;5Iiii-J:t9'J~nve. 200 amps or less '. . ~$'6'3:001l23P?
Cit)' Evct-~, 'Phone b0'1,~:~1bt: ,:':, ~~: :::::~::~ ~~~ ::~:: '. - ;l~~'.~~-
. .. .' . 601 amps to 1000 am~s'" $163.00
Supervisor Li~ense Number 46:0% S.:' :.;:-:.,;'; . Over 1000 amps/volts '.. $375.00 =
. ..' ,<: 1 . ( .' :/1.' ":;:(.:;'.',"--, ,.Reconnect Only:,..,.,: :.~ $ :50.00---,-
ExplratlOnDate.(OOI ::2..0()~.:.. ' ...-:,....0.;.' '. '. . .:".'.,.,'." .'", .
," ." ;... ~, ".:", ;'~','-'.~~'~ ~,' -~;':,_;.: ~:<':'.'~'. '.T~nli)~ral")' Scn'ic'es'.o;.Feed~rs . \' ,'. . '," :.' ~~ ."
. Constr Cantr. Number 1-563 f i :'::;l':;.y::,':;o;'~.;/J:nstallation, Alte~ation tir'Reloe',itiOll'';: ",.. :~'.
; Expiration Date" ~k2.1 O:-$7-.::~:.,<t,t(~t':~;?rEt ,;>~~~, ~mpso; ie~s':;;' . ':'. ,\.,;':":;~~:;~.~
, .. . ...:.,~, ',' ..;.:"":;:.,,.' '. 201 amps io 400 amps . " ''''''''':'- $69.00 ...:.::-.:..
.. .: Signa~urc of SUJlcl-vising Electrician - ' ""_. Ov-cr 401 to 600 ~inps ~ $100:'OO.~
Ovcr 600 amps oUOOO volts'see . . ,. .
"BIl nbore '
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. '. .. Owners Name\)WO
.~.., ': Address\~ ~r<:'~\Qo-tJ . One Circuit laW reqwre~woutf$43.00 ~ .
. .'. ~. (\ "U"'"!A \ _ r:1f)' ATTENTION:oregon the Oregon Utility.. .
. Cit). . MDJl.1 Phone~\o follow 1~\Gh;A'd!lilillrl'a~CWcllit O~~\~t~~~fert' . nA ocJ
. . , . S . tifiCa\\\!if,@ler.llern;TthOSe ru OAR r~_($)3.00 ~,
OWNER INST ALLA nON '-lOa R 952-001.001? \hrO~gh f the" rules I
The installation is being made on . 1~9~liS'OU;\II!1!IYS[(Sh:Vitc/(eetI~Pn~t incl~H\)qle
property I 0\\'0 which is not intended 0 ili~aI1~iil.' i~IRl!atid.Mote.1~e tet~ificalion.
for sale. lease or rent. ca l"1I11~ O>)If''''atIQ!On Utl.lily No $,,0,00
. b~rT 1I ~""'.-~ 44)- -
num :>Ig Oll.tlinc Ligiltihg>.<>.?-?3 "--- $51l.00 _
Owners Si~:(Ni1tE: Limited EllergylRes 525.00
. THIS PERMIT SHALL EXPIRE IF THE WORK Limited ElIerg~-JComm 545.00
';U711JfiiiHi i.ii~[)tt\ thl$"PffiMIT I;&IllQ.h,11l Electric Permit InsJlection FeCis S45.IlO + Surcharges
COMMENCED OR IS ABANDONED fOR
ANY 180 DAY PERIOD. 4. SUBTOTAL OF ABOVE ~l?=>
70/0 State Surcharge I O.~
8% Administratire Fcc ,." .""\0
\() \. f'\~
D, Branch CirclIits .
New Alteration or Extension Per Panel
TOTAL.
CITY OF S!NGFIELD SYSTEMS DEVELOPMEN_ORKSHEET
JOURNAL OR JOB NUMBER: Com2004.00086. sink addition
NAME OR COMPANY: Vincent Zawodny
LOCATION: 5764 Ridse Court
TAX LOT NUMBER: 18020411 t17900
DEVELOPMENT TYPE: SFD Gara~e and Shop. sink addition
NEW DWELLING UNITS 0 BUILDING SIZE (SF' 0 LOT SIZE (SF):
I. STORM DRAINAGE
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Ir;-
10
18
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C/l
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DIRECT RUNOFF TO CITY STORM SYSTEM
I IMPERVIOUSS.F. x I COSTPERS.F. 1 I CHARGE
I 0.00 I $0.290 = I $0.00 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS
I IMPERVIOUSS.F. 1 x I COSTPERS.F. 1 x I DISCOUNTRATE I I DISCOUNT
I 0.00 I $0.290 I 50% I = I $0.00
ITEM I TOTAL - STORM DRAINAGE SDC SO.OO
2. SANITARY SEWER. CITY
so.OO
11070
-.
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU
I I I $22.64 S22.64 I 1091
B. IMPROVEMENT COST: I
I NUMBER OF DFU's I x COST PER DFU
I I $17.21 S17.21 1092
ITEM 2 TOTAL - CITY SANITARY SEWER SDC =, S39.85
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x : NUMBER OOF UNITS I x I COST PER TRIP x INEWTRlPFACTORI
I 9.57 I $17.23 I 1.00 SO.OO 1093
B. IMPROVEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIPFACTORI
I 9.57 I I 0 I $76.01 I 1.00 I 50.00 1094
ITEM 3 TOTAL - TRANSPORT AnON SDC ~ , 50.00
4. SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I 0 I I $314.63 = 50.00 11054
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU
I 0 I $214.23 = 50.00 1055
MWMC CREDIT IF APPLICABLE (SEE REVERSE) so.oo 1054
MWMC ADMINISTRATIVE FEE 50.00 11056
ITEM 4 TOTAL - MWMC SANITARY SEWER So( = , 50.00
SUBTOTAL (ADD ITEMS 1, 2, 3, & 4) = , 539.85
5. ADMINISTRATIVE FEE:
I SUBTOTAL I x I ADM. FEE RATE 1= CHARGE
I $39.85 I 5% $1.99
TOTAL SANITARY ADMINISTRATION FEE: 1.99 1079
TOTAL TRANSPORTATION ADMINISTRATION FEE: $0.00 1078
Virginia Jurasevich 4/20/2004 TOTAL SDC CHARGES = $41.84
PREPARED BY DATE
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DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES, UNIT EQUIV ALENT ~ DRAINAGE FIXTURE UNITS
(NOTE, FOR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EQUIV ALENT UNITS
I BATHTUB .
0 0 3 = 0
I DRINKING FOUNTAIN 0 0 1 = 0
I FLOOR DRAIN 0 0 3 = 0
IiNTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0
I INTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = 0
I LAUNDRY TUB 0 0 2 = 0
ICLOTHESW ASHER / MOP SINK 0 0 3 = 0
ICLOTHESWASHER.3 OR MORE LEA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
I RECEPTOR FOR REFRIG / WATER STATION / ETe. 0 0 1 = 0
I RECEPTOR FOR COM. SINK / DISHWASHER / ETe. 0 0 3 = 0
I SHOWER. SINGLE STALL 0 0 2 = 0
ISHOWER. GANG (]'lUMBER OF HEADS!. 0 0 2 = 0
ISINK: COMMERCIAURESIDENTIAL KITCHEN 0 0 3 = 0
ISINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0
ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1
IURINAL, STALL! WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET. PRIVATE INSTALLATION 0 0 3 = 0
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS I
.EDU (Equivalent Dwelling Unit) is a discharge equivalent 10 a single family dwelling unit (20 DFU's) set at 167 gallons per day ..J
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MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE
'j
YEAR
ANNEXED
CREDIT RA TE/$ I ,000
ASSESSED V AWE
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I
I
I
BEFORE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
55.04
$5.04
54.95
S4.88
54.75
54.58
$4.41
54.20
S3.88
$3.50
$3.07
S2.60
$2.14
$1.71
SI.52
SLl8
$1.19
$1.03
$0.87
$0.68
$0.46
$0.27
$0.09
SO.04
IS LAND ELGIBLE FOR ANNEXATION CREDIT?
(Enter I for Yes, 2 for No)
IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT?
(Enter I for Yes, 2 for No)
BASE YEAR
o
o
1979
CREDIT FOR LAND (IF APPLICABLE)
VALUE /1000 CREDIT RATE
$0.00 x $5.04
~ ,
$0.00
CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION)
VALUE /1000 CREDIT RATE
$0.00 x $5.04
o
TOTAL MWMC CREDIT
=
$0.00
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2004-00086
COM2004-00086
COM2004-00086
COM2004-00086
COM2004-00086
COM2004-00086
COM2004-00086
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.y of Springfield Official Receipt
.velopment Services Department
Public Works Department
RECEIPT #:
1200400000000000519
Date: 04/21/2004
2:47:22PM
Description
Fixture
Minimum/Adjustment Plumbing
Perm ServlFdr 200 amps or less
Add, Alter, Extend Circ Ea Add
Sanitary Sewer - Reimbursement
Sanitary Sewer - Improvement
SDC Sanitary/Storm Admin
Amount Due
14.00
31.00
63.00
24.00
22.64
17.21
1.99
$173.84
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Payments:
Type of Payment Paid By
Check
4/21/2004
Amount Paid
VINCENT ZA WODNY
djb
168
In Person
Payment Total:
$173.84
$173.84
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