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Home My WebLink AboutPermit Building 2005-3-14 ., Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 PhDne 541-726-3676 Fax 541-726-37691nspection Line . . CITY OF SPRI~lj1'l~LD Building/Combination Permit PERMIT NO: COM2005-00207 ISSUED: 03/14/2005 APPLIED: 02/22/2005 EXPIRES: 09/14/2005 VALUE: $ 194,456.00 SITE ADDRESS: 1038 Diamond Street ASSESSOR'S PARCEL NO,: 1703342103300 Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New PROJECT DESCRIPTION:, Aspen Park subd IDt 16 - single family residence Owner: JONATHAN DRISCOLL Address: 317 S 67TH ST SPRINGFIELD OR 97478 I ~R!AGTORINFORMATION I IUIIOW rules . -. "yon law fe Contractor .NotificatiDn C adOpted by tM~l~ YOE:U1iration Dlite OWNER In OAR 952-0 enter. Those rtJ/ regon Utility , OWNER 0090. You m 01-0010 throu es are set folth MARSHALLS INC calling the ay Obtain cOPi~~Q/lR952-OO1.12/23/2005 SHAD CHASAN SUlUUNir f". .~en!er. (Not...l~fl}~e rules bIt 01114/2006 ' BUlnm])jJi~jj'r&F,tfl,~;t~Otine , . . ~UJ'..z;i44). 01) # of Stories: 1 Height of Structure.. 19.50 Type of Heat: Forced. Air Gas Water Type: . -:;-'Gas Range Type: Electric Energy Path: Path 1 Sprinkled Building: nla Contractor Type General Electrical Mechanical Plumbing # of Units: Primary Occupancy GrDup: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of BedroDms: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: 18,00 5,00 5,00 63.00 20,00 Residential Phone Number: 541-988-1921 Phone 541-747-7445 541-741-3553 1 R-3 U VN 4 LDt Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant LDad: 437 8,712 1,911 I DEVELOPMENT INFORMATION I THIS PEFiMIT t:!;j Aur.9verlay Dist: ALL EXPIRE IF THE \^'nR '-'\ 'til/r-,f' J ''''''';-,., .V K COM~.Str'i\'t Trees.Rqd'THIS PERMIT I" 3 P',~~ld D"rl "fR'(J' ,y~'OT ANY < ave _' ,ve,!I. :ABANDONED C) es 'AlGftL;if(i::'iWRl~~: Fz4?40 REQtJIRED PARKING Total: 2 Handicapped: Compact: I PUBLIC IMPROVEMENTS I Sidewalk Type: Downspouts/Drains: Fully Improved Yes, Curbside 5' Curb and Gutter Notes: No hook-up to City Infrastructure until Public Improvements accepted by the City: storm drainage piped to Curb face 2/28/2005 CAS Pal!e 1 of4 Status Issued 225 Fifth Street, Springfield, OR 541-726--3753 Phone 541-726--3676 Fax 541-726--37691nspection Line Description Dwellines Garaee Tvpe Df Construction V Wood Frame Garaee Fee Description Plan Review Residential -Mechanical Issuance Fee- + 10% Administrative Fee + 7% State Surcharge 3 Baths One & TWD Family Addressing Assignment Appliance Vent Building Permit Curbcut Permit Dryer Vent Exhaust Hoods Furnace - up to 100,000 btu Gas Fireplace Gas Outlets 1-4 Heat Pump Plan Review Major - Planning PW Disc - 2nd Permit (Street) Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 Sanitary Sewer - 1mprDvement Sanitary Sewer - Reimbursement SDC MWMC AdministratiDn SDC MWMC Improvement SDC MWMC Reimbursement SDC Sanitary/Storm Admin SDC Transpo Admin SDC Transpo Improvement SDC TranspD Reimbursement Sidewalk Permit Storm Drainage Impervious Area Temp Power 200 amps or less Vent Fan Willamalane Single Family Total Amount Paid . I Valuation Descrintion I $ Per Sq Ft or multiplier $96,00 $25,00 Square Footage or Bid Amount 1,911.00 440.00 Total Value of Project Fpp< PIi4J Amount Paid $568,36 $10,00 $147.54 $103.28 $306.00 $31.00 $6,00 $874,40 $80,00 $6,00 $9,00 $12,00 $15.00 $4,00 $12,00 $103,00 $-30,00 $106,00 $57,00 $438,72 $576,96 $10,00 $865.31 $82,03 $132,15 $62.80 $772.49 $175.13 $8j).00 $978.36 $50,00 $18,00 $1,000,00 $7,662,53 Date Paid 2/22/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 ,3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3/14/05 3114/05 3/14/05 3/14/05 3/14/05 Paee 2 of4 . U 11' OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00207 ISSUED: 03/14/2005 APPLIED: 02/22/2005 EXPIRES: 09/14/2005 VALUE: $ 194,456.00 Value Date Calculated $183,456,00 $11 ,000.00 $194,456,00 02/22/2005 02/22/2005 Receipt Number 1200500000000000231 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 2200500000000000291 . . CITY OF ~rK.ll-l\d'lJj,LD Building/Combination Permit PERMIT NO: COM2005-00207 ISSUED: 03/14/2005 APPLIED: 02/2212005 EXPIRES: 09/14/2005 VALUE: $ 194,456.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Initial Review Plannine Review I Plan Reviews I 02124/2005 02124/2005 APP SKG 02/24/2005 03/1112005 APP TAJ Needs survey because Df minimum setbacks. 02/24/2005 02128/2005 APP CAS ND hook-up tD City Infrastructure until Public Improvements accepted by the City; Storm drainage piped te curb face 212812005 CAS 02124/2005 03/1112005 APP TCM Public WDrks Review Structural Review 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. ErDsionlGrading InspectiDn: After aU erosion measures are in place. Sidewalk - Curbside: After forms are erected but prior tD placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete, Ufer Electrical Ground: Install ground rod at fDDting and call for inspectiDn in conjunction with footing andlor foundation inspectiDn, FODting: After trenches are excavated, Foundation: After forms are erected but prior to concrete placement, PDst and Beam: Prior to Ooor insulation Dr decking. Floor Insulation: Prior to decking, Shear Wall Nailing: Before covering sheathing with finish materials. Framing Inspection: Prior tD cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover, Ceiling InsulatiDn: Prior tD cover, Drywall: PriDr to taping, Boits Installed in CDncrete: To be dDne by a State Certified Special InspectDr, Provide inspectiDn test reports tD City Building Inspector, HDld Downs Installed: Special InspectiDn performed priDr to placement Df CDncrete, Provide report to City Building Inspector. Final Building: After all required inspectiDns bave been requested and apprDved and the building Is complete. UnderODDr Plumbing: Prior to insulation or decking. UnderOoor Drain: Prior to cover or placement of concrete. Rough Plumbing: Prior to cover and Including required testing. Water Line: Prior to filling trench and including required testing, Sanitary Sewer Line: Prior to filling trench and including required testing, StDrm Sewer Line: PrlDr to filling trench, Final Plumbing: When all plumbing work is complete. UnderOoor Mechanical, Prior to insulation or decking and including required testing, Rough Gas: After line is installed and required testing and capped if not attached to an appliance, Gas Service: After line is installed and line has been connected tD a minimum of one appliance including required testing. Presure test done at this point, Rough Mechanical: Prior to Cover Final Gas: When all gas work is complete. Paee30f4 . . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00207 ISSUED: 03/14/2005 APPLIED: 02/22/2005 EXPIRES: 09/14/2005 VALUE: $ 194,456.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Final Mechanical: When all mechanical wDrk is complete, Temporary Electric: Approval required prior to Utility Company energizing pole, Rough Electric: Prior to Cover Electric Service: Approval required prior to utility company energizing service. Final Electric: When all electrical work is complete, , '1/ By signature, I state and agree, that I .t;'ve carefully examined the completed applicatiDn and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be dDne in accordance with the Ordinances of the City Df Springfield and the Laws of the State of OregDn pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure withDut permissiDn of the Community Services DivisiDn, Building Safety, I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project, I further agree tD ensure that all required inspections are requested at the proper time, that each address is readable frDm the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. " -' -5/f~k~ oat/, / ~~ . .,;1. ..."'ILUI3i ~.gnalure ,/ Paee4 Df4 225 Fifth Street Springfiel,d, Oregon 97477 541-726:3759 Phone . GPiiif4 It:..; . Job/Journal Nnmber COM200S-00207 COM200S-00207 COM200S-00207 COM200S-00207 COM200S-00207 COM200S-00207 COM200S-00207 COM200S-00207 ' COM200S-00207 COM200S-00207 COM200S-00207 COM2005-00207 COM200S-00207 COM2005-00207 COM2005-00207 COM200S-00207 COM2005-00207 COM2005-00207 CbM2005-00207 COM2005-00207 COM2005-00207 CbM2005-00207 COM2005-00207 COM2005-00207 COM2005-00207 COM2005-00207 COM2005-00207 COM2005-00207 COM2005-00207 COM200S-00207 COM2005-00207 COM200S-00207 Payments: Type of Payment Check :1 3/14/2005 RECEIPT #: ~ of Springfield Official Receipt welopment Services Department Public Works Department 2200500000000000291 Date: 03/14/2005 Description Addressing Assignment Willamalane Single Family Residence Wiring 1000 Sq Ft Temp PDwer 200 amps or less Residence Wiring Ea Addtl SOO Sidewalk Permit Curbcut Permit PW Disc - 2nd Permit (Street) StDrm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Reimbursement SDC MWMC Improvement SDC MWMC Administration SDC Sanitary/StDrm Admin SDC Transpo Admin Building Permit 3 Baths One & Two Family Furnace - up to 100,000 btu Vent Fan Appliance Vent Exhaust Hoods Dryer Vent Gas Outlets 1-4 Gas Fireplace Heat Pump -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Plan Review Major - Planning Paid By JON DRISCOLL Received By djb Page I of I Item Total: Check Number Authorization Batcb Number Number How Received 5148 In PerSDn Payment Total: 11 :28:02AM Amount Due 31.00 1,000.00 106.00 50,00 57,00 80.00 80.00 (30,00) 978.36 576,96 438,72 175.13 772.49 82.03 86S,31 10.00 132.IS 62,80 874.40 306,00 12,00 18,00 6,00 9.00 6,00 4,00 15.00 12.00 10.00 103.28 147.S4 103,00 $7,094,17 Amount Paid $7,094.17 $7,094,17 , . CITY OF SPIGFIELD SYSTEMS DEVELOPMENTeRKSHEET JOURNAL OR JOB NUMBER: COM2005-00207 NAME OR COMPANY: 1038 Diamond SI LOCATION: Jon Driscoll TAX LOT NUMBER: 1703342103300 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF' 2348 LOT SIZE (SF): L STORM ORAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F, x, COST PER S,F. 'I CHARGE I 3156.00 '$0,310' = $978.36 I RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS , IMPERVIOUS S.F. I x , COST PER S.F, I x I DISCOUNT RATE' , I 0,00 I $0.310 I 50% I = I ITEM 1 TOTAL - STORM DRAINAGE SDC '$978.36 DISCOUNT SO.OO - - 2 SANITARY SEWER - CITY 9309 $978.36 tJ) tJ..l Cl 10 I~ ~ tJ) 6 ~ 11070 A. REIMBURSEMENT COST: , NUMBER OF DFUs' x , 24 I COST PER DFU $24,04 B. IMPROVEMENT COST: I NUMBER OF DFU's I x 24 I $18.28 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I $1,015.68 3. TRANSPORTATION A. REIMBURSEMENT COST: , ADTTRlP RATE , x I 9.57 , B. IMPROVEMENT COST: , ADT TRIP RATE I I 9.57 I I NUMBER OF UNITS' x I I 'I COST PER TRIP $18.30 'I x 'NEW TRIP FACTORI I 1.00 , I ~ , NUMBER OF UNITS' x , I I I' = , COST PER TRIP $80,72 $947,62 x INEW TRIP FACTORI , 1.00 , x ITEM 3 TOTAL - TRANSPORTATION SDC ~. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: 'NUMBER OF FEU's I x , 1 I ICOST PER FEU $82,03 B. IMPROVEMENT COST: INUMBEROI FFEU's I x, 'COST PER FEU , $865.31 MWMC CREDIT IF APPLICABLE (SEE REVERSE) MWMC ADMINISTRATIVE FEE ITEM 4 TOTAL - MWMC SANITARY SEWER SDC ~ I 5957.34 - SUBTOTAL (ADD ITEMS I, 2, 3, & 4) ~ I $3,899.00 5, AOMINISTRATIVE FEE: I SUBTOTAL x I ADM, FEE RATE ,~ $3,899,00 , 5% I TOTAL SANITARY ADMINISTRATION FEE: TOTAL TRANSPORTATION ADMINISTRATION FEE: CHARGE $194.95 5576.96 $438.72 5175.13 5772,49 = $82,03 = $865.31 50.00 510,00 , 132.15 $62,80 Cheryl Slaymaker TOTAL SDC CHARGES 2/28/2005 PREPARED BY DATE =, $4,093,95 I 'I 1091 1092 11093 I 1094 11054 I 1055 1054 1056 I I 1079 11078 . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT - DRAINAGE FIX11JRE UNITS II (NOTE, FOR REMODELS, CALCULATE ONLY THE NET ADDmONAL FIXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EOUIV ALENT UNITS I BATHTUB 2 0 3 = 6 I: IDRINKING FOUNTAIN 0 0 1 = 0 1 ; FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE / OIL / SOLIDS / ETe. 0 0 3 = 0 I INTERCEPTORS FOR SAND / AUTO WASH / ETe. 0 0 6 = 0 I !LAUNDRY TUB 0 0 2 = 0 ICLOTHESW ASHER / MOP SINK 1 0 3 = 3 ICLOTHESW ASHER - 3 OR MORE (EAl 0 0 6 = 0 IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 IRECEPTOR FOR REFRlG / WATER STATION / ETC. 0 0 1 = 0 IRECEPTOR FOR COM, SINK / DISHWASHER / ETe. 0 0 3 = 0 ISHOWER. SINGLE STALL 0 0 2 = 0 I SHOWER. GANG (NUMBER OF HEADS\. 0 0 2 = 0 I SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3 I SINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 3 0 1 = 3 IURlNAL, STALL / WALL 0 0 5 = 0 TOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRlV A TE INST ALLA TION 3 0 3 = 9 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 24 .,:EDU (Equivalent Dwellin~ Unit) is B d.isc~ equivalent to a sinRle familv dwelling unit (20 OFU's) set at 167 gallons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE 'L YEAR CREDIT RATE/$I,OOO ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 2 BEFORE 1979 $5,29 (Enter I for Yes, 2 for No) 1979 $5.29 IS IMPROVEMENT ELGIBLE FOR ANNEX, CREDIT? 2 1980 $5.19 (Enter I for Yes, 2 for No) I 1981 $5.12 BASE YEAR 1979 1982 $4.98 I 1983 $4.80 CREDIT FOR LAND (IF APPLICABLE) 1984 $4,63 VALUE I 1000 CREDIT RATE 1985 $4,40 $0,00 x $5,29 ~ , $0,00 il 1986 $4,07 1987 $3,67 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) I 1988 $3,22 VALUE / 1000 CREDIT RATE 1989 $2,73 $0,00 x $5,29 0 1990 $2,25 1991 $1.80 1992 $1.59 TOTAL MWMC CREDIT = $0,00 1993 $1.45 1994 $1.25 1995 $1,09 1996 $0,92 1997 $0.72 1998 $0.48 1999 $0.28 2000 $0,09 2001 $0,05 , , . . . Pennit#: CO'io11.00. DOZ.07 -' . . ...... ../ ", ," Construction Contractors Board 700 Summer St NE Suite 300 PO BDX 14140 Salem OR 97309-5052 Phone: 503-378-4621 Web Address: www.ccb.state.or.us Address: /038 DtS b'A--'O_c:\ -::.+ Date: --;$ II'! /a r- , 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 licensed 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, mechanical and plumbing permits, Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need not submit this statement. This statement will befiled with the permit. Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: ~l. !tr 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. D 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 ~ 38. I will be my own general contractor. If! hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. Ifl change my mind and hire a general contractor, I will contract with a contractor who is licensed with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the ahove information is correct and that I have read and do understand the Information Notice to Property 0 ahout Construction Responsibilities on the reverse side ofthis form. /?' rh,,,,,;':uiift:!:r ~tOr- ~ _ (White copy to issuing agency permit file, pink copy to applicant.) Property _ owner.dDc 06-01-04 , ' , ' AdnlIi1g 1II~~ dllllll" iOiWlIi Gelliel1'lIIl ~lIitll"lIIctlllll"? . INFORMATION NOTICE TO PROPERTY OWNERS ABQUT CONSTRUCTION RESPONSIBILITIES NOTE: This Information Notice to Properly Owners about Construction Responsibilities was developed by the Construction Contractors Board in accordance with ORS 701.055(5), passed by the 1989 Oregon Legislature. If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and concerns. JEmlPlloyer lResponllsfilbillities You will, in most instances, be ruled to be an "employer" and the contractors you contract with will be "employees" if you use contractors not licensed with the Construction Contractors Board to do labor in constructing or to assist in the construction or improvement of a residential structure. As the employer, you must comply with the following: Oregon's Withholding Tax Law: As an employer, you must withhold income taxes from employee wages at the time employees are paid. You will be liable for the tax payments even if you don't actually withhold the tax from your employees. For more information, call the Department of Revenue at 503-378-4988. Unemployment Insurance Tax: As an employer, you are required to pay a taX for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Department at 503-947-1488. The Oregon Business Identification Number (BIN) is a combined number for both Oregon Withholding and Unemployment Insurance Tax. To file for a BIN, call 503-945-8091 or www.dor.state.or.us/formsnav.htmll for the appropriate forms. Workers' Compensation Insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees. If you fail to obtain workers' compensation insurance, you could be subject to penalties and be liable for all claim costs if one of your employees is injured on the job, For more information, call the Workers' Compensation Division at the Department of Consumer and Business Services at 503-947-7815. U.S. Internal Revenue Service:' As an employer, you must withhold federal income 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 1-800-829-4933 or visit their web site at www-irs"wv. OtllneI1' Resjpo1lllsfilbfillfitfies amI! Areas of COnllcernlls Code Compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requir~ments that Il)3Y be brought to your attention through inspections. Liability and Property Damage Insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint over spray, water damage from pipe punctures, fire or work that must be redone. , I '. Time: Make sure you have sufficient time to supervise your employees. Expertise: Make sure you have the skills to act as your oWn general contractor, to coordinate the work of rough-in and finish trades, and to notify building officials as the a,,}'w}'.;ate times so they can perform the required inspections. If you have additional questions call the Construction Contractors Board (503-378-4621) or write the agency at PO Box 14140, Salem, OR 97309-5052. Property _ owner, doc 06-01-04 , . , 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(S41)726-3753 . F~~~%3689 ELECTRICALPERMiTAPPUCATION ' ~~f 'l",:,o,"A r .~. %~ City Job Number C> -OO2CJ1- Date '4, t6 <'0'11' ~ 'lOt ~~~ "1')", ....... ".0 .....e~,"6"'h: 3. JG:6i\:,if..:..e,."a,hi:n"', . 'jfi.l;,,~~l~~1 ..... ...'1';.~ '?: . "Ii.;. t~ ($"" ....... IC'I.; 61", . '" ,/ - -~.. '%' ..r' ,II lilli' I ~~,.. .;..,~. ~Jk;;~. A. .New1R~!'!.~,D,tial-SiDgle or.Mul, . lIw' nit, Service Included 1000 sq. ft. Dr less Each additional 500 sq. ft. or portion thereDf 1, ItE<>:€AiF~~.N~~S:T-~\r!i~4'!tr~ 101 (1) Dfa"""...J ~-r LEGAL DESCRIPTION 1"'1-o13Lr2.( 0 1'J 00 JOB DESCRIPTION SI-v,t., ~",/Iv 10 /~AU- I Permits are DDD-traDsferable aDd expire If work Is nDt started wltbln 180 days oftssuance or If work Is, SuspeDded for 180 days, ' . , ~B',Jl:,~~~,"" ". .~., ..~ , ~'. . ' , 1 )06.00 51,00 Each Manufact' d HDme or MDdular Dwelling SerVice or Feeder $50.00 2, ~eqtfiRd~~i;i!J.&ST~A!i:I@MClNhY" B. Services or, Feellers - IDstalllatioD, \\:lterations oTIRelocatioD: Elec:I-;ontracto~--' '-"'-::~;T~N:or~""~~~ "'" ...., ". $'63.00" .... , / .follOW rUle:; adop. ~1~ql}6mforft $ 75.00 Address '" ,/ Notificatlo~ center. j.:Am""lln~ $125.00 10 Uf\n "",-OOHlO1 ViRlUQITu'.n~- . '" "c009(j:voumayobUBWcl/jlllJll<of~- $163.00 City ",t~. ....PhDne.. II'. - <fa centet9'(Nd~ $375.00 / ';~b;r for the o&tFr"ll'-ll1f~$ 50.00 ,.." CenterI81"~'):~~ SuperVisor License Number C. .l~~~€i!;!S1!!!:iF;ffiI~~ " Installadon, AlteradoD or RelocallDD 200 Amps or less f 20 I Amps to 400 Amps '10 I Amps tD 600 Amps ." ...,,, 'E' , Over 600 Amps or 1000 Volts see "B" above. Sig;,ature of SuperVising Electrician :NOTIC : D, c'~ . ' , 1HIS PERM\ .' . ,," ~n>!IT I~M AUT H 0 R I ZE 1)I'oW~J,-l{i;ali"II,0...;nenSIOD-per' - -.' ENCm' 1~)<r!I'f(9if\.BANDONED.FOR , vulJ\M 0 0 acli~dditil'nal Circuit or with J I. IJ '7 Ii. NY 1 B IS '~e '6~Feeder Pennit Owners Name OV\a<Mo4t", rhCo{{ , Address 311-~. b7-/<-. Sf E. City )f!f/~lrclJ Phone 'IB8-/92/ , Expiration D~te , Consn-o Conn-. Number ,/ Expi,ration Date ! OWNER INSTALLATION The installation is being made on ,,",_, 'J I own which is not intended for sale, lease or rent. "'" ~ ~ - ' InspectIon Request: 726-3769 $ 50.00 $ 69.00 ' $100.00 9),00 $ 43,00 $ 3.00 Pump or irrigation Sign/Outline Lighting Limited EnergylResidential Limited Energy/Commercial $ 50.00 $ 50.00 $ 25.00 $ 45.00 Minimum Electric Permit Inspection Fee Is $45,00 + Surcharges 4.I$~TAli:.!OFIABO,~ '71 \. 00 I~/If ? 1'\0 lZ tlq. 2-/ 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)IBuilding FormslElectrical'Pcrmit Application 1-03.doc