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Home My WebLink AboutPermit Building 2005-1-20 ,. CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-01587 ISSUED: 01120/2005 APPLIED: 12/28/2004 EXPIRES: 07120/2005 VALUE: $ 4,000 00 Status Issued 225 FIfth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIOn Lme SITE ADDRESS 453 PIONEER P ARKW A Y WEST ASSESSOR'S PARCEL NO 1703352307800 SPRINGFIETYPE OF WORK Foundahon TYPE OF USE PROJECT DESCRIPTION FoundatIOn for moved house Owner FOUMAL MICHAEL W & LAURA A Address 1750 WASHINGTON ST EUGENE OR 97401 Contractor Type General Electrical ^TTE~IT'Q~J ~"~7~ 'EFf: rSEftdrB5 j ':'u ~1oI follow rrco~~FORM'~j.tciN' NotlflcaL _ _ __ . __!! !L!~ HU,,"IJ Contractlfl.OAR 952-001-0010 through OA~fi\Ril. OWNER 1f090 You may obtain copies of the rules by ALERT EL~tfflc:enter. (Note' the telEif2~l7fle ~:;~.~:~~~ki~~TiBNiv" " # ofUmts Primary Occupancy Group Secondary Occupancy Group' Primary ConstructIOn Type Secondary ConstructIOn Type # of Bedrooms R-3 # of Stories' HeIght of Structure Type of Heat Baseboard Elect Water Type' Electric Range Type Electric Energy Path Sprmkled Bmldmg n/a VN 2 Front yard Setback SIde 1 Setback SIde 2 Setback Rearyard Setback Solar Setbacks NOTlClr'DEVELOPMENT INFORMATION I THIS PERMIT SHALL EXPIRE IF THE WORK .t24"ooORIZED Ur03;;flayIU8tPERMIT IS NOT HIStoric C';j'QOJ1ENCED GIfl~tre,e,uWi~~j}Il<tJ FOR ANY 180 DAY pfiWS'/JDrlve Rqd Ves 1000 % of Lot Coverage 2670 000 I PUBLIC IMPROVEMENTS I Street Improvements New ReSldenhal '~l. Me:, 41C5\ tk\ ExpiratIOn Date Phone OS/22/2005 541-747-2213 Lot SIze Sq Ft 1st Floor Sq Ft 2nd Floor Sq Ft Basement Sq Ft Garage/Carport Sq Ft Other Occupant Load REQUIRED PARKING Total 2 HandIcapped Compact Fullv Improved Yes SIdewalk Type DownspoutsIDrams Setback 5' Curb and Gutter Storm Sewer AvaIlable Specla] InstructIOn Notes Storm dram age plpcd to curb face 1/5/2005 CAS Encroachment permIt for samtary hook-up to eXlStmg tap Pa2e 1 of 4 '~~S~R~GF,IE~ . J "!.J.~ , --.' ~- ~~ ~---- Status Issued 225 F,fth Street, Spnngfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 InspectIon Lme DescnptlOn Tvpe of ConstructIon FoundatIOn Onlv Use BId Amount Fee DescnptlOn Plan RevIew ReSidentIal + 10% AdmmlstratIve Fee + 7% State Surcharge Add, Alter, Extend CIrC Ea Add Addressmg AssIgnment Encroachment PermIt FoundatIOn PermIt Moved Structure Plumbmg Conn Plan RevIew Major - Planmng Plan RevlewlResldentIal Hourly Samtary Sewer - Ist 50 Feet ServIce Reconnect Storm Sewer - Ist 50 Feet Water Lme - 1st 50 Feet Total Amount PaId Plannme: Review 01103/2005 PublIc Works RevIew 01103/2005 CITY OF SPRINGFIELD' . Building/Combination Permit PERMIT NO: COM2004-01587 ISSUED: 01/20/2005 APPLIED: 12/28/2004 EXPIRES: 07/20/2005 VALUE: $ 4,000.00 I Valuation DescrlOtlOn I $ Per Sq Ft or multIplIer $100 Square Footage or BId Amount 4,000 00 Value Date Calculated Total Value of ProJect $4,000 00 $4,000 00 12/28/2004 Fpp" P"iri I Amount PaId Date PaId ReceIpt Number 2200400000000001551 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 1200500000000000084 $39 39 $3176 $22 23 $2700 $31 00 $12000 $60 60 $45 00 $103 00 $67 50 $45 00 $50 00 $45 00 $45 00 12/28/04 1120/05 1120/05 1120/05 1120/05 1120/05 1120/05 1/20105 1120/05 1/20105 1120/05 1/20/05 1120/05 1/20/05 $732 48 I Plan Reviews I 01/19/2005 APP T AJ DRC2004-00027 approval by HIstone RevIew Board finaled 7/1 0/04 Storm dram age pIped to curb face, encroachment permit for Samtary hook-up to eXlStmg ladenal1l5/2005 CAS 01/05/2005 APP CAS Page 2 of 4 ._~~ '-',--, ~.. - ~ ~ -- CITY OF SPRINGFIELD. Building/Combination Permit Status Issued 225 FIfth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspectlOn Lme PERMIT NO. COM2004-01587 ISSUED. 01/20/2005 APPLIED. 12/28/2004 EXPIRES: 07/20/2005 VALUE: $ 4,000 00 Structural RevIew 01/03/2005 01/04/2005 WE DLM Structural RevIew 01/13/2005 01/20/2005 APP DLM Structural questIOns on eXlstmg bldg for applIcant ModIficatIOns may be needed for cell Jsts/rafter support & mtenor footmgs Contacted applIcant and dcslguer 1/3/05 dIm Talked to applIcant and desIgner by phone 1/4/05 Met w/ desIgner at counter to dIscuss the problems WIth teh upper level He agreed to add foundatIOn support for the mtenor bearmg wall Upst3\rs areas re habItable spaces to be resolved later RevIsed foundatIOn plan & cross sectIon submItted 1/13/05 dim FoundatIOn only - See documents for plan review comments To Request an InspectIOn call the 24 hour recordIng at 726-3769. All Inspection requested before 7:00 a.m. will be made the same working day, inspectIOns requested after 7:00 a.m. will be made the folloWIng work day. ~"irp(l~ Ufer Electncal Ground Install ground rod at footmg and call for mspectlOn 10 conjunctIOn WIth footmg and/or foundatIOn mspectIon Footmg After trenches are excavated FoundatIon After forms are erected but pnor to concrete placement Post and Beam Pnor to floor msulatIon or deckmg Floor InsulatIon PrIOr to deckmg Fmal BUlldmg After all reqUIred mspectlOns have been requested and approved and the buIldmg IS complete Water Lme Pnor to fillIng trench and mcludmg reqUIred testmg Samtary Sewer Lme Pnor to fillIng trench and mcludmg reqUIred testmg Storm Sewer Lme Pnor to fillIng trench Underfloor Plumbmg Pnor to msulatlOn or deckmg Underfloor Dram Pnor to cover or placement of concrete Rough Electnc Pnor to Cover Electnc ServIce Approval reqUIred pnor to uhlIty company energlzmg serVIce Fmal Electnc When all electncal work IS complete Paee30f4 -~~~ u....ru. ~.,' CITY OF SPRII"Iuf<U,LD ' Building/Combination Permit Status Issued PERMIT NO: COM2004-01587 ISSUED: 01/20/2005 APPLIED. 12/28/2004 EXPIRES: 07/20/2005 VALUE: $ 4,000.00 225 FIfth Street, Sprmgfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-37691nspectIOn Lmc By SIgnature, I state and agree, that I have carefully exammed the completed apphcatIon and do hereby certIfy that all mformatIon hereon IS trne and correct, and I fnrther certIfy that any and all work performed shall he done 10 accordance with the Ordmances of the CIty of Springfield and the Laws of the State of Oregon pertammg to the work described herem, and that NO OCCUPANCY WIll be made of any structure wIthout permISSIon of the CommuDlty ServIces DIVIsIOn, BUlldmg Safety I further certIfy that only contractors and employees who are 10 comphance wIth ORS 701 005 wIll be used on thIs project I further agree to ensure that all reqUIred mspechons are requested at the proper hme, that each address IS readahle from the street, that the permIt card IS located at the front of the property, and the approved set of plans WIll remam on the SIte at all hmes durmg constructIOn ~Vw~ \/00/05 Owner or Contractors SIgnature Date Page 4 of 4 CITY OF Sh..O'lGFIELD SYSTEMS DEVELOPMEN1" 3bRKSHEET JOURNAL OR JOB NUMBER NAME OR COMPANY LOCATION TAX LOT NUMBER DEVCLOPMLNT TYPE NEW DWELLING UNITS COM2004-01587 Laura r oumal 453 PIOneer P!<y W 1703352307800 o BUILDING SIZE (SF o LOT SIZE (SF) o I STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S F x I COST PER S F CHARGE I 000 I $0310 I = I $000 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPCRVIOUS S F I x I COST PER S F I x 1 DISCOUNT RATE I I DISCOUNT I 000 I I $0310 I 1 50% I ~ 1 $000 ITEM 1 TOTAL - STORM DRAINAGE SDC $000 I 2 S-\NITARY SEWER - CITY A REIMBURSEMENT COST I NUMBER OF DFU's I x I 0 1 $000 COS f PER DFU $24 04 $000 B IMPROVEMENT COST I NUMBER OF DFU', I x I 0 I $1828 $000 'I Ir/J ~ 10 ,0 I~ I~ i; I 1070 1091 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I $000 3 TRANSPORTATION A REIMBURSEMENT COST I ADT TRIP RATE I x 1 NUMBER OF UNITS 1 x I COST PER TRlP x INEW1RIPFACIORI I 957 1 1 0 1 I $1830 1 100 1 $000 1093 B IMPROVEMENT COST I ADT TRlP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEW TRlP FACTORI I 957 I I 0 I I $80 72 I 100 I $000 1094 ITEM 3 TOTAL - TRANSPORT A nON SDC ~ I $000 4 SANITARY SEWER - MWMC A REIMBURSEMENT COST INUMBER OF FEU's 1 x ICOST PER FEU i 0 I I $82 03 = $000 1054 B IMPROVEMENT COST INUMBER OF FEU's I x ICOST PER rcu I 0 I $865 31 = $000 ]055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $000 1054 MWMC ADMINISTRATIVE FEE $000 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~ , $000 SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ , $000 5 ADMINISTRATIVE FEE I I SUBTOTAL x ADM FEE RATE I~ CHARGE 1 $000 5% $000 I TOTAL SANITARY ADMINISTRATION FEE #DIV/O' 11079 TOTAL TRANSPORfArION ADMINISTRATION FEE #DIV/O' 11078 Cheryl Slaymaker 1/5/2005 TOTAL SDC CHARGES $000 II PREPARED BY DATE -- DRAINAGE FIXTURE ~NIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES);. UNIT I::.QUIV ALENT = DRAINAGE FIXTURE UNITS (NOTE FOR REMODELS CALCULATE ONLY THE NET ADDITIONAL FIXTURES) NO OF FIXTURES DRAINAGE UNIT FIXTURE FIXTIJRE TYPE NEW OLD EQUIVALENT UNITS I BA rIlTUB 1 1 3 = 0 II I DRINKING FOUNTAIN 0 0 1 = 0 IFLOOR DRAIN 0 0 3 = 0 -I INTERCCPTORS FOR GREASE / OIL / SOLIDS / ETC 0 0 3 = 0 I IiN fERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 I CLOTHESW ASHER / MOP SINK 0 0 3 = 0 I CLOTI-lESW ASHER - 3 OR MORE (EA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 I RECEPTOR FOR REFRlG / WATER STATION / ETC 0 0 1 = 0 I RECEPTOR FOR COM SINK / DISHWASHER / ETC 0 0 3 = 0 I ISHOWER SINGLE STALL 0 0 2 = 0 I 'SHOWER GANG (NUMBER OF HEADS) 0 0 2 = 0 I ISINK COMMERCi-\LiRESIDENTIAL KlTCHEN 1 1 3 0 ISINK COMMERCIAL BAR 0 0 2 = 0 SINK WASHBASINIDOUBLELAVATORY 0 0 2 = 0 I SINK SINGLE LAVATORY/RESIDENTIAL BAR 1 1 1 = 0 j URINAL, STALL / WALL 0 0 5 = 0 TOILET. PUBLIC INSTALLATION 0 0 6 = 0 TOILET, PRlVATE INSTALLATION 1 1 3 = 0 MISCELLANEOUS DFU TYPE NUMBER OF CDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 0 "'EDU (EqUlvalent Dwellmg Urnt) IS a discharge equivalent to !_~e faImly dwelling ~.~~ ~~O DFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE BASED ON COUNTY ASSESSED VALUE I YEAR CREDIT RATE/$I,OOO ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 2 I BEFORE 1979 $529 (Enler I for Yes. 2 for No) I 1979 $529 IS IMPROVCMENT ELGlBLE FOR ANNEX CREDIT? 2 I 1980 $519 (Enler 1 for Yes 2 for No) I 1981 $512 BASE YEAR 1979 I 1982 $498 , 1983 $480 CREDIT FOR LAND (IF APPLICABLE) I 1984 $463 VALUE / 1000 CREDIT RATE I 1985 $440 $000 x $529 ~ I $000 I 1986 $407 I 1987 $367 CREDIT FOR IMPROVEMENT (IF AFTCR ANNEXATION) I 1988 $322 VALUE/lOOO CREDIT RATE I 1989 $273 $000 x $529 ~ , 0 I 1990 $225 1991 $180 I 1992 $159 TOTAL MWMC CREDIT = $000 I 1993 $145 I 1994 $125 I 1995 $109 I 1996 $092 I 1997 $072 I 1998 $048 I 1999 $028 I 2000 $009 I 2001 $005 , , - Construction Contractors Board 700 Summer St NE SUIte 300 PO Box 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address www ccb,state or us Penmt # (.UvY' = 0 ,- 01 )- 8" 7 t..( 5"3 ?, ()-lA =<- ~LS ~~/;/'1' I Date (-Z-O -O~ Address Issued by Statement: Information Notice to Property Owners About Construction Responsibilities Note Oregon Law, ORS 701 055(4) requIres residential constructIOn permit applicants who are not lzcensed with the ConstructIOn Contractors Board to sign the following statement before a bUilding permit can be Issued This statement IS reqUired for residential bUilding, electrical, mechamcal and plumbing permits Licensed architect and engineer applicants, exempt from lzcenszng under ORS 701010(7), need not submit thIs statement This statement will befiled with the permit Fill In the appropnate blanks and Initial boxes I and 2, and either box 3A or 3B ~1 ~2 I own, reside In, or Will reside In the completed structure I understand that I must become lIcensed as a construction contractor If the structure IS sold or offered for sale before or on completIOn o 3A My general contractor IS (Name) (CCB #) I Will Instruct my general contractor that all subcontractors who work on the structure must be lIcensed with the ConstructIOn Contractors Board " OR ~ 3B I Will be my own general contractor If! lure subcontractors, I Will lure only subcontractors lIcensed With the Construction Contractors Board If! change my mInd and hire a general contractor, I Will contract With a contractor who IS lIcensed With the CCB and Will nnmedlately notify the office Issumg tlus bmldmg permit of the name of the contractor I hereby certify that the above information IS correct and that I have read and do understand the Information Notice to Property Owners about Construction Responslblbtles on the reverse Side of this form. ~~ \7 /~<3/0+ (Signature of permit applIcant) . - I (Date) (WhIte copy to ISSUing agency permit file, pznk copy to applzcant) Property_owner doc 06-01-04 , , . ~ ~ I A~till1lg as' J{olUlr-6WllI' GerrneIrall. COll1ltr3lct([)Ir? . J " INFOfiMATION NOTICE TO 'PROPERTY oWNERS ABOU1..C9NSTRUCTION RESPONSIBILITIES -, - , , NOTE This Information Notice to Property Owners about Construction Responslblltfles was developed by the ConstructIOn Contractors Board In accordance with ORS 701 055(5), passed by the 1989 Oregon Legislature . , If you are actrng as your own contractor to construct a new home or make a substantJalnnprovement to an eXlstmg structure, you can prevent many problems by bemg aware of the followmg responslbll1hes and concerns Employer Responsibilities " 1 ~ ~ \ ' You WIll, m most Instances, be ruled to be an "employer" and the contractors you contract With wJ11 be "employees" If you use contractors not, licensed With the ConstructJon Contractors Board to do labor m construchng or to assist m the ~r. \ , .. I .... , ~ construclion or Improvement of a resldenlial structure As the employer, you must comply with the following' '4 l.r. Oregon's Withholding Tax Law: As an employer, you must Withhold mcome taxes from employe~ wages at the lime employecs are paId You Will be hable for the tax payments even If you don't actually WIthhold the tax from your employees For more mfonnahon, call the D~p:"';"Hent of Revenue at 503-378-4988 . Unemployment Insurance Tax: As an employer,--you are requIred to pay a tax for unemployment msurance purposes on the wages of all employees For more mformatlOn, call the Oregon Employment Department at 503-947-1488 " ... The Oregon Busmess IdenhficatlOn Number (BIN) IS a combmed number f~r both Oregon 'Ylthholdmg and Unemployment Insurance Tax To file for a BIN, call 503-945-8091 or www dor state 01 us/formsnav hlmlJ for the app...vp~...ate forms , . j , Workers' CompensatIOn Insurance: As an employer, you are subject to the Oregon Workers' CompensatIOn Law, and must o!>t?ln wqrkers' compensalion msur~nce for your employees If you fall to obtam workcr;s' compensatIOn msurance, you could be' subject to penallies and be hable for all claim costs If one of your employees IS mJured on the Job For more mformatJon, call the Workers' Compensalion DIVlslon at the Department of Consumer and Busmess Servtces at 503-947-7815 U.S, Internal Revenue Service: As an employer, you must WIthhold federal mcome tax from employees' wages '- You WIll be lIable for the tax payment even If you didn't actually Withhold the tax For a Federal EIN number, call the IRS at t:800-829..4933 or-Vlslt thell web sIte at www 11 s l!0" . ,. , , ,,' Other ~esponsibilities .~n~ ,Areas 'of Coric~r~s Code Comphance' As the permIt holder for thIS project, you are responSible for resolVlng any faIlure to meet code reqUirements that may be brought to your attentIOn through mspectlOns .. ' l ~ . I Liabibty and Property Damag~ insurllDce' Conta~t your msurance agent to see If you have'~dequate msurance coverage for aCCidents and omiSSIons such as fallmg tools, pamt over spray, water damage from pIpe punctures, fire or work that must be.redone t....' .... /",... \ ~ I . r...... .-\ 1- ,t --,~_...- \ - - Time. Make sure you have suffiCIent lime to supervIse your employee; Expertise. Make sure you have the slalls to act as' yoUr own general contractor, to coordmate the work of rough-m and fimsh trades, and to notIfY bUlldmg offiCials as the appropnate hmes so they can perform the reqUIred mspectlOns If you have addItIOnal queslions call the ConstructIOn Contractors Board (503-378-4621) or wnte the agency at PO Box 14140, Salem, OR 97~09-5052 Property_owner doc 06-0]-04 225 FIfth Street S~dngtield, Oregon 97477 541-726-3759 Phone "~~AINa!l~ . I ~I ~.,: "'.ty of Sprmgfield OffiCIal ReceIpt _ ~velopment ServIces Department . PnblIc Works Department Job/Journal Number COM2004-0 1587 COM2004-01587 COM2004-01587 COM2004-0 1587 COM2004-01587 COM2004-01587 COM2004-0 1587 COM2004-0 1587 COM2004-0 1587 COM2004-01587 COM2004-01587 COM2004-01587 COM2004-01587 Payments Type of Payment '> Check 1/20/2005 RECEIPT #: 1200500000000000084 Date: 01/20/2005 DescriptIOn Encroachment PennIt Plan RevIew Major - Plannmg Foundatwn PermIt Addressmg AssIgnment Samtary Sewer - 1st 50 Feet Water Lme - 1st 50 Feet Storm Sewer - 1st 50 Feet Moved Structure Plumbmg Conn ServIce Reconnect Add, Alter, Extend Orc Ea Add Plan RevIew/ResIdentIal Hourly + 7% State Surcharge + 10% Admmlstratlve Fee PaId By NATION CHRISTIAN ORGANIZATION Item Total Check Number AuthorizatIOn Received By Batch Number Number How Received dJb 1203 In Person - Payment Total Page I of I 11.48 54AM Amount Due 12000 10300 6060 3100 4500 4500 4500 4500 5000 2700 6750 2223 3176 $693 09 Amount Paid $693 09 $693 09 l";l!':-: :., :'~';-;':'-GmbF' &_.J:rNGFiEIlEf OREGON, .{ : >:.: J .. .." .' . / . ~ . . . . f.. . .": .' : ','" \ .1' ~ T " ~ . . 225 FIFfH STREET. SPRINGFIELD, OR 97477 . PH (541)726-3753 . FAX (54Irolloiillw. -(j.- 0:. "'0 ELECTRICAL PERMI~'PLICATION "I <9,,, <'0 o"~~"OI<9 /'/\;u-7/TTl ) - 7 v~'" 0, ~ City Job Number U,'/ .;./// -Q ,~ Date 01}.,.)0 19- r6) ..s'v6 . ~h ~ 90.-: ~/,I<-,<, ~~"$'~~~~~*~~ %,M~:'ijQ- ~_A:ttM>MYl'1(i.t1,-,";';;"f'f-~~~~"," '~'k.w"'~ ~ fi-~~"".?:'J0~"""~fj1;-^';'\tl\if"X--;~ I -EOeATION~OflINSTJ!LfWI'10NN1J;l!f:- Jz::l 3" COMPLE1 E.F.EE Su. Eli,Q.~d "';:$:;':;'~)~>;;'?'\L~-J ' ~,.,"illr.~.......~ ,,~..t ~_4!";i.M"2,..d.~jf4"$JM^,,~~ ~ ~%i'tL~J~~C~ ~"&:t".J:~'"'- J-"Iik.. ~'" ..%~..~I'j,:;I"~~'ltDi~ 4 53 ,/J14.J~fi.,if, ~Vf cf-m!J~II€.,,+'U~r-_ ~ " F ;4i:~~" ,V'l LEe AL DESCRlPTION A ~,,'\,_~~~1~B,~~~n~;.?~fjL t~~ ,'~'f~a'\ellj,!!!Min~ /703<,,') 2.< o7f6/YO Servlcelneluded >5 JOB DESCRIPTION ! 000 'q ft or less k'B'D>tJ.0I!l!I ,~~~ k :~~~0~d~~~~~~1500 'q ft or Permits dre non-transferable and expire If work IS not started l\lth1ll180 days of Issuance or If Vtork IS Suspended for 180 days Each Manufad'd Home or Modular DwellIng ServIce or Feeder ~50 00 ~teoNfIDt(Jf:(jR7NSTAijHATl;)&,(JNL~ B ~~~1:~::o~F~~d~i~I~~rarii;tti6li,~~&~ar.~J~;(R~mritlb~~ 2 ~).fukL~~~'4\wff/;kAd; '}1'i.1~ -F7~"'k." t.#h~1S!~ If-;:;;;~~...JJt:~~~,.%bfj!\k~:-rMAt~~~'"""_fk:;;';':"ji:":0".-P~~"A0(......"",,,~"" ..,') \.. Electrical Contractor ~4 ~ C 200 Amps or Ie" $ 63 00 (0'1 -rH ("'- 20 I Amps to 400 Amps $ 75 00 Address i 10 iJ 28 :::,1, 401 Amps to 600 Anll'youto $12500 .:::.f)o --t '7'7'id\ON Q;O'g~\h~\~{?W~Utihty $16300 CIty.J.;:&.1 ~ fi e:ili)Phone 7 '-t 7 -~Ie': ad~\lfrqliilbtA~l!\'j{,V~set forth $37500 '? IIC<:.\\on cenwco1lJPd'lDIil~ OAR 952.001- ~ $ 50 00 C:;-/J,€?c.) , 952-001-0010 throug Illes by -, 24'2 . C In OI\R riljj:~"I.u..".1So{)f th~i?l:i__" '~,~ -'"'~J]:'~~1o'ii-f,jfc\Jl;-,jj'''':--q' V'''''''J Superv,"or License Numb(er /~~~ .-J7~~~\\I~~Ut:'~e~@4N'~t~~~~s]:s,,,,,;r:-~~~~~,:~~~ ExpiratIOn Date I D- ~D ber for thfltQ'\~~B~!2'Jlt1\}'l or RelocdtlOn - CenteJda imps or Ie" $ 50 00 Comtr Contr Number I Z /12'- 20 I Amps to 400 Amp' $ 69 00 S /1 "? .f-...~ 401 Amps to 600 Amps $10000 ExpIratIOn Date L- G-V / _ Over 600 Amps or 1000 Volts see "B" above Xg at1urte O/ftsu,perVlsmg Eplpectnclan D Ne" Alteration or ExtenslOlI Per Panel I,~ d One CIrcuIt $ 4300 / ~ -, - EachAddltIOnalClrcUltorwltl, ^ ^ ~7dO pwners Name LhM A 'fflw44ffl- ServIce or Feeder PenUlt Ii"" $ 0 00 '2- / I Addre" / 7 ;-'0 I, /,. - "-1__ .,../ -r-:, ,7 ~\ CE', E \ 1'"a1;Z~fl1[~"ij;lf~m.~~~~pfiliB'iid@)f~E~~IM:~~1:llft;:fn~1 . 7iC. _1(1~, I" I'L!~_ '1ti's PERM 11t'8rrn~,?~W~b~~"'U'~"'~_c., -"""".1"""",Q\1! City P& :'17101 Phone Sf5'-+7.6/n--\OR\Zq,'1Al~N~r\'$'lfH~JIWmONED fOR $ 5000 COMMtNCS1~ u~I'(J'1lLlghtmg $ 50 00 OWNER INST ALLA TION p,N'{ 180 Q[;-\lSe ~nergYlResldentlal $ 25 00 The 1m lallatIon IS bemg made on property I own whIch LImIted Energy/Commercial ~ 45 00 IS not llltended for sale, lea...c or rent Owners S,gnature MInimum Electnc Permit Inspecllon Fcc IS $45 00 + Surcharges 4 ~~EW6"" E:t&~~~lPY-.JWJ~~#?" 7% State ~urcharge 10% AdmInistratIve Fee Inspechon Request 726-3769 TOTAL Shared Dnve(T )/BUlldmg Fonns/Electncal Penml ApplicatIOn 1-03 doc