HomeMy WebLinkAboutPermit Electrical 1992-2-11
SPRINGFIELD
,.. ~')~";J;(I"iW/~.'.
, '
225 FIFTB STREET
i~~~gi~~RE~~~~~ 9~~1~~~'.'-
n.:-.. 1,1, ,r,.,,'.!h11'OOClJ'MlI
_~ OFFICE: 726-3759 ","~V~I,'
~ 1. LOCATION OF INSTALLATIoWftl
~ ~Or:;.,,=l- ,,?rJ/nJ _
f' n.r-&.'&"""" ,.
LE1;AL DESCRIPAION . ~
S ';34 TI7s K.'%.1 72..' J49c;i)
ELECTRICAL PERKIT APPLICATION
'''';:'::~:.y Job Number q \(J\o)<, \
3. ' COHPLETE FEE SCHEDULE BELOII
JOB DESCRIPTION '- t") _
5'il'9SJ..r.z.. f;w"" I L/(" ~(.tJ'/7~G
Permits are non-transferable and expire
if work is not started within 180 days
of issuance or if work is suspended for
180 days.
2. CONTRACTOR INSTALLATION ONLY B.
Electrical Contractor '1"h{)VYl1m'1 Eke,
AddresskClIo -~, ;:)Cl~ 1.l1/I-
City t::u9ino Phone (Pfflo/{o2f(
Supervisor License Number SO 17 C
Expiration Date / O~J-{;l )
Constr C~ntr. Number dO-d.-n& 0
Expiration Date /(}:....; -4/
Signature of supervi~~~trician
.~-+. U.-,.. .
- . O~ ~STALLATION
Name
Address
City
Phone
The installation is being made on
property I own which is not intended
for sale, lease or rent.
Owners Signature:
~~~~~--------~-----~~--~-----------
RECEI~ '''\\ -)- ~. J N CJ...
RECEI~D · BY ~ ~
New Residential-Single or
Multi-Family per dwelling
~~L':~~ :ncluded: .
It ems
1500 sq. f t. or less I
Each additional 500
sq. ft or portion (
thereof
Each ~anuf;d Borne or
Modular Dwelling
Service or Feeder'
unit.
Cost Sum
$ 85.00 ~5", C!O
$ 15.00 ; f". ()O
$ 35.00
Servic~s or Feeders (10 Branch Circuits
included)., Installation, Alterations
or Relocation:
100 amps or less
lUl amps to 400 am~~
401 amps to 600 amps
601 amps to 1000 amps
Over 1000 amps/volts
Reconnect Only
$ 35.00
., Qu.6: 1:'::":00
$ 80.00
$130.00
$300.00
$ 35.00
C. Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps or less I $ 35.00 ""? 5": CO
201 amps to 400 amps $ 40.00
Over 401 to 600 amps $ 80.00
Over 600 amps or 1000 volts see 1t8n above
D. Branch Circuits
Nev, Alteration or Extension Per Panel
Miscellaneous (Service/feeder
-Each installation
Pump or irrigation
Sign/Outline Lighting
Signal Circuit or
limited energy panel
One Circuit
Two to ten Circuits
Each Addt'l ten or
portion thereof
E.
5.
SUBTOTAL OF ABOVE
5% State Surcharge
TOTAL
,
$ 35.00
$ 50.00
$ 15.00
not included)
$ 36.00
$ 36.00
$ 36.00
fr~- '1.P
j.'.I~
aJ-...,'. y)
13S~b I
to. ?:5
11f.?s
Metropolitan
Wastewater
Managen"'\ent
Commission
.
.
CQ:,',f/,lSS1W !/E!.~5t~.S
F.~~ S!'1r1{:!-rllc~n! Counci!;,~~~:,
Slt'.'t D~::l'-fu~~:le l21 Rp;lrC5f,.:i:!,(-
$:0:1 En;~:::.:;;-S;::'1;jie;a laJ ;;ep:c~er.;i:i...t
C~;'jS lc:s~n-S;lrin~:if:ld CC1:Jncll:'fl~:"
Ct':!is '.:m:-r.-liinf C('ur,:r L2:! Rf;"f'S(-"::c:'~'~
,It;:), RU$l-L~nE Ccun:)' Com:ni~S':"H
t.~2:;, \"'esllin~-~uce:'le La,' F.e~:e~rnlt.:i'..e
FIFiH AND A STREETS - SPRII-:GFIELD CITY HALL - EPR!i,GFiELD, OREGOi'J 97"77 TELEPHO!,E (503) 747,"55i
7J''f 0\1MC CONNECTION CHARGE
Building Address: ~~ \ Q" 0 8,(6)\ 1.)
-- ~ ~.... - ,.
Reference Number: MDQ,,'?f\ \ ~
O.ner:\ & Q~ '-t l~Ai- .
Address~&O\O I Q.~
City: t)~
Tax Lot
Number:J4Q{)Q
State:
Phone Number: L?~-q4..~(
(UJpf)fm ~ Zip: QfJ1ns
o
~esidential Fee ($222.00)
$ d)f) f:J 00
Commercial Fee (nev non-residential developmentl
remodel)
Total fixture unit charge (see reverse of this form) $
SUBTOTAL $
Credit Due (see reverse of this form)
<$
3g', <(f
>
TOT AL I1\1MC CHARGE
$
I ~3jl
Receipt Number:
Building
J -_
By:fJ//JrV
Job Number:.9JDCoRL
Da te Received: ...8 '
/ I . q{).
8f)Q~
Received
.
.
Fixture Unit Calculation Table: Number of nev fixtures multiplied by unit
equivalEnts. NOTE: For remodEls, calculate only the !:ET addi tional fixtures.
Fixture Type
# of
Fixtures
Unit
Equivalents
Fixture
Units
Sa th tub. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Drinking fountain............... ....... ...
Floor drain.......................o,.......
IntercEptors for grease/oil/solids/etc....
Interceptors for sand/auto vash/Etc:.: .'...
Laundry tub/clothEs ..'asher................
Clothes vasher (3 or more)..... ...... .....
110bile home park trap (1 per J,!.H.)........
Receptor for refrig/vatEr station/Etc....~
Receptor for Commer sink/dish.shr/etc.....
Shover, single stall......... ... ..... .....
Shover, gang (pEr head)...... ... ... ...,...
Sink, bar, commercial........ '" ..... .....
Sink, commercial/industrial/etc. ..........
Urnial, stall/".all........................
Vash basin/lavatory, single..... ..........
Vater closet, public installation.........
Vater closet, private........ .............
Miscellaneous: ..........
2
1
2
3
6
2
6
6
1
3
2
1
2
3
2
1
6
4
..........
Total Units:
Total fixture units
x $13.25 each = Total Charge: S
Credit Calculation Table: Based on total value of property at time of permit
application.
Year "l,nne>:Ed
j;o the ci tv
Credit per $1,000
assessed value
19/-b
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
$2.66
$2.64'
$2.53
$2.41
$2.19
$2.04
$1. 69
$1. 35
$1. 15
$0.92
$0.59
$0.23
Credit
;(.6"6
Rate
x S 14,<Oz..o
J..ssessed Value
S
'53, "tf
Total Credit