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Home My WebLink AboutPermit Building 2004-1-6 -. .. Status Issued 225 Fiflh Street. Springfield, OR 541-726-3753 Phone 541-726-3676 Fa, 541-726-3769 I nspcclion Line . CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2003-01238 ISSUED: 01106/2004 APPLIED: 1211112003 EXPIRES: 07106/2004 VALUE: $ 139,809.00 SITE ADDRESS: 4042 Douglas Dr ,\SSESSOR'S :'.\RCEL NO.: 1802061111600 PROJECT DESCRIPTION: SFR Springfield TYPE OF WORK: Single Family Residence TYPE OF USE: New Residential Owner: BRUCE WIECHERT Addr"ss: 3375 PARK HILLS EUGENE OR 97405 I CONTRACTOR INFORMATION I Contractor License BRUCE WIECHERT CUSTOM HOMES INC 101717 L & E ELECTRIC INC 105475 COMFORT FLOW 460 STEVE R JOHNSON 65065 BUILDING INFORMATION I Sidewalk Type: Fullv Improved Curbside 5' Yes NOTICE: DownspoutslDrains: Curb and Gutter NO SEWER HOOK-UP OR Q~~!m.Vlllf~IUIDl~me I~~T PLANS ARE ACCEPTED BY PUBLIC W9,wmoRIZED UNDER THIS PERMIT IS NDT COMMENCED OR IS ABANDONED FOR ANY 180 DAY PERIOD. Contractor Type GCIlt'r:d EIL'l'lril':I1 i\lt'(.'hallkal Phlll1hing If- ut"Unils: Prilll:Jr~' Ol'l't'llancy Group: ~;l'r' 'ldary C' i1!l:lI1CY Group: Prirll:lr~' Cun...:ruclion Type Sl'l"ollthry CO!1'itruction Type: # of Ikdrnull1s: SETBACKS Fr(lI1I~'anl S~:lhack: Silk 1 ~~i.'lh:lrl,: ~idl' 2 ~;elh:l ~: 18.00 13.60 5.00 19,60 15,00 I~l':'ry~~nl Sl"'''lck: SoLI:" S ':h:IC', : Stn'dlll1pnl\"'llH.-'nfs: SllJrlll Sew('r :\vailable: Spl't';al III~L ' ,;011: t':olt's: ~. Phone Number: 541-686-9458 Expiration Date 09/16/2006 03/30/2004 06/27/2005 03/12/2004 Phone 541-686-9458 541-933-2653 541-726-0100 541-342-3765 1 R-3 U-l VN # of Stories: 1 Lot Size: Height of Structure 18.00 Sq Ft 1st Floor: Type of Heat: Forced Air Gas Sq Ft 2nd Floor: Water Type: Gas Sq Ft Basement: Ra~~~J.~.\:i'Oregon law&Wq:ntees YSlf. f:it ~arage/Carport A-mi'cl!W Mil: d b th~on Sliliii~ther: fO~I~~~~I~,:-~~::_eTh~e rules are _~~iOUS Surface Area: I DEvIDi1li:~""lJN"ORMl'Tf(l~.......it~~-;~.s \ , I... "' tfJ:I'" , \ "lit> 0090. YOu:a~nt~O;'(N~te: the telepho~e REQUIRED PARKING ~tuat " r~ on Utility NotificatIon Total: 2 n#JSl~f ~~~!t;.@i .~nn_~32.2344)2 Handicapped: Paved lJr,ve'ti.qil: Y Compact: es 32.00 5,850 1,426 446 3 % of Lot Coverage: I PUBLIC IMPROVEMENTS' Paee 1 of4 -~. PRING.FIl!L.~_ I.. '!~-,:' "ll. '" ~ aI!; '. .,.. ... --.., + .,. ~ - ." Status ::;:.;ued 225 Fifl h Strwt. Springfield, OR 541-726-375:1 Phone 541-726-3676 Fax . 54 t -7 2G-l illt) Inspection Line I)l'srrillliftll Tvpe of Construction I)wdlil1~s V Wood Frame Garaee Gara!.!l' . . U1:t' OF SPRINGFIELD Building/Combination Permit PERMIT NO: cOM2003-01238 ISSUED: 01106/2004 APPLIED: 12/1112003 EXPIRES: 07/06/2004 VALUE: $ 139,809.00 I Valuation Descrintion I $ Per Sq Ft or multiplier $90,60 $23.80 Square Footage or Bid Amount 1,426.00 446.00 Value Date Calculated Total Value of Project $129,195.60 $10,614.80 $139,810.40 12/1112003 12/1112003 ~ Fl'l'lkscripliuJI Amount Paid Date Paid Receipt Number Plan Rc\'il.:\\ H,csidl'ntial $452,17 12/11103 1200200000000002582 .....:\Il'('h:lIlkal hSu3lH.'e Fee- $10.00 1/6/04 1200400000000000011 + 10'X, "\dm:l~istrative Fee $121.37 1/6/04 1200400000000000011 + 7'~;, St:ll~ SIII"charge $84.96 1/6/04 1200400000000000011 :2 Balhs (Jill: or Two Family $254.00 1/6/04 1200400000000000011 :\ddn";sill~', hsignnll'nt $8.00 1/6/04 1200400000000000011 Ap!'lialll'c \' "l~ $6.00 1/6/04 1200400000000000011 Building PlTlllit $695,65 1/6/04 1200400000000000011 Cl:rbcllt - C\l'rwidth Appl $35,00 1/6/04 1200400000000000011 ClIrlll'lIt p "!' .-:t $75.00 1/6/04 1200400000000000011 I.;'~'l'r VCIlI $6,00 1/6/04 1200400000000000011 E\'hallsl Ifnt .1,\ $9,00 1/6/04 1200400000000000011 Fllrll,Il"l' - 1 '0100,000 btu $12.00 1/6/04 1200400000000000011 Cas Fi 'l:pla~'t' $15,00 1/6/04 1200400000000000011 C:l-;Oulll'l': J-.t $4.00 1/6/04 1200400000000000011 Plan I{c\,j/", - Planning $59.00 1/6/04 1200400000000000011 I'\V .\1'111 " . " - 2nd l}ermit $-30.00 1/6/04 1200400000000000011 ){esitlt'llCl' , iug 1000 Sq Ft $106.00 1/6/04 1200400000000000011 Ht'sidl'lIn" "' 'ing Ea AddtlSOO $38.00 1/6/04 1200400000000000011 S:wil<l:'Y ~; .,' -Improvement $344.20 1/6/04 1200400000000000011 ~':'llit;lry Sl" "I' - Reimbursement $452.80 1/6/04 1200400000000000011 SDC :\1\\"" . .\dministration $10.00 1/6/04 1200400000000000011 snc .\:\\'.'.. - Improvement $214,23 1/6/04 1200400000000000011 snc .\:\1'". l{cil11hursement $314.63 1/6/04 1200400000000000011 SDC S'lIlit ''-'torm Admin $101.92 1/6/04 1200400000000000011 ~.:C Tr:\I"j: \dlllin $53.94 1/6/04 1200400000000000011 SDC Trail... Improvement $727.42 1/6/04 1200400000000000011 SDe Tnlll"i:1, {{ciJllhursement $164.89 1/6/04 . 1200400000000000011 Sidewalk I' ;it $75,00 1/6/04 1200400000000000011 Storm Dr:" , ',C Impervious Area $889.00 1/6/04 1200400000000000011 Tl'!lIp !'unl'l' :10 am ps or less $50.00 1/6/04 1200400000000000011 Vl'1I1 F'll! $18.00 1/6/04 1200400000000000011 \\'ill:lll :':,I'i" "illgle 17amily $1,000.00 1/6/04 1200400000000000011 ., . I Amount Paid $6,377.18 Paee 2 of 4 _SPRI"lGFI> , o~~ , ...A'A ~ ,! ~ ~ . . e Status '. sued 22, Finh Slrrel. Springfield, OR 541-726<'1.- rhnnc 5-11-72(1<HI7 "ax 5.11-716<\7, Ilspcction Line IlIilialltl'\'i.\\ Pll:lIllIill!! I'~ " i~w Ful;lil: ',\,u' . !{c"icw Stru('lllnll ""\'j(.w To Rl"IU\' ,,:11 Ill' ,1. "a\', . . CITY OF ~rKlj~lJt<lJi.L1J Building/Combination Permit PERMIT NO: cOM2003-01238 ISSUED: 01106/2004 APPLIED: 12/11/2003 EXPIRES: 07/06/2004 VALUE: $ 139,809.00 Plan Reviews I 12/12/2003 12/12/2003 APP RJB 12/12/2003 12/31/2003 APP TAJ 12/12/2003 12/26/2003 APP VRJ NO SEWER HOOK-UP OR OCCUPANCY UNTIL PUBLIC IMPROVEMENT PLANS ARE ACCEPTED BY PUBLIC WORKS, Applicant has applied for overwidth driveway, application in review by PW transportation, 12/26/2003. 12/12/2003 12/2912003 APP TCM 'n inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. the same working day, inspections requested after 7:00 a.m. wiII be made the following work , Rr~n<nprtjn~ 1)r.".- rlpdr;ral Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or' fOIlP ion inspection. 2 Fill: . Afh'r trenches are excavated. J FlItll.. :UII: After forms are erected but prior to concrete placement. -l P. .,. :;calll: Prior to floor insulation or decking. ::; 1:0 .'Ialion: Prior to decking. (, Shr.. all Nailing: Before covering sheathing with finish materials, 7 Fra" '1~ Inspcclion: Prior to cover and after all rough in inspections have been approved. X \Val:' 1~II!:1ti(ln: Prior to cover. 9 Cl'ili'l'! Insulation: Prior to cover. 1 fI !)r~'\" 'I: PrillI' to taping, 11 ri,,,' ';Id;n~: After all required inspections have been requested and approved and the building is complete. 12 l:I\"' ; n- Plumbing: Prior to insulation or decking. J:1 l'" "'1' Drain: Prior to cover or placement of concrete. J-I Ro!'" "ltnhing: Prior to cover and including required testing. J' \\'. "'I': Prior to filling trench and including required testing, J (, S" "ewrr Line: Prior to filling trench and including required testing. 17 :--:1411 ~.'\cr Line: Prior to filling trench. 1 N F:II:: t'llIhing: When all plumbing work is complete. II) U lid, Ill" i\ ICl'hanical. Prior to insulation or decking and including required testing. "" J{o", '"" After line is installed and required testing and capped ifnot attached to an appliance, 2 J ( ; as S . '-c: ;\ fter line is installed and line has heen connected to a minimum of one appliance including required I ':<i Ii' , l'S II rc test done at this point. 22 I{lll< 'vdwllical: Prior to Cover 2J Fio,l: Whrn all gas work is complete. "4 Fi. hall;,-a1: When all mechanical work is complete. 2, '1'" )' FII,ctric: Approval required prior to Utility Company energizing pole, 26 1<1":' ,:l'l'lrit': Prior to Cover 27 r, l' ',':('vicr: Approval required prior to utility company energizing service, 2X J, i , rir: When all electrical work is complete. Paee 3 of 4 -t~- fij' . . CITY OF SPRINGFIELD' Building/Combination Permit _SPRINOPI1. 'I ",';r- Slatlls lied PERMIT NO: cOM2003-01238 ISSUED: 01106/2004 APPLIED: 12/11/2003 EXPIRES: 07/06/2004 VALUE: $ 139,809.00 2~5 Fifth SII 541-72(,-37: 5..tl-72(i-:1(I~ S.11-7~(I-.r" t. Springfield, OR . IJOIIC .X ''illertion Line I:~' ,i~llalll"" 'I"le alld agree, that I have carefully examined the completed application and do hereby certify that all illh"''''''';1 :111 is Iruc and correct, and I further certify that any and all work performed shall be done in accordance with tile Ordillal ,rille Cily of Springfield and the Laws of the State of Oregon pertaining to the work descrihed herein, and tllat i\0 O( ,',\i\CY will be made of any structure without permission of the Community Services Division, Building Safety. I furlllcr n " ':,al Iluly contractors and employees who are in compliance with ORS 701.005 will be used on this project., I furtlln a, "eusurc that all required inspections are requested at the proper time, that each address is readable from the slnTI. Iha: crmif eard is located at the of the pro rand-the'approved set of plans will remain on the site at all "'""{j Jt"" I - Co, - 0 '-f "& 0" 1It'!" Hf ( '..l'"tor~ Signature Date Paee 4 of 4 225 Fifth Street ' Springfield, Orcgon 97477 541-726-3759 Phone Job/.luurllal j\'umber COM2003-0 1238 COM2003-01238 COM2003-0 I 238 COM2003-0I238 COM2003-01238 COM2003-01238 COM2003-01238 COM2003-0I238 COM2003-0I238 COM2003-01238 COM2003-01238 COM2003-0I238 COM2003-0I238 COM2003-01238 COM2003-01238 COM2003-0 I 238 COM2003-0I238 COM2003-01238 COM2003-0 1238 COM2003-0I238 COM2003-01238 COM2003-01238 COM2003-0 1238 COM2003-0 I 238 COM2003-01238 COM2003-01238 COM2003-0I238 COM2003-01238 COM2003-01238 COM2003-0I238 COM2003-01238 COM2003-01238 Payments: Type of Payment CreditCard sr;lINOFlm..O _.~ -.:::-~.'1t Heecipt #: 12IJU41J1JIHIIJUIJIJlHHHlII UC~l'ripliun Addressing Assignment WillamaIane Single Family Temp Power 200 amps or less Sidewalk Permit Curbcut Permit Curbcut - Overwidth Appl PW Mult Disc - 2nd Permit Storm Drainage Impervious Area Sanitary Sewer - Reimbursement Sanitary Sewer - Improvement SDC Transpo Reimbursement SDC Transpo Improvement SDC MWMC Improvement SDC MWMC Administration SDC SanitarylStorm Admin SDC Transpo Admin SDC MWMC Reimbursement Building Permit 2 Baths Onc or Two Family Furnace - up fo 100,000 btu Vent Fan Exhaust Hoods Appliance Vent Dryer Vent Gas Outlets 1-4 Gas Fireplace -Mechanical Issuance Fee- Plan Review - Planning Residence Wiring 1000 Sq Ft Residence Wiring Ea Addtl 500 + 7% State Surcharge + 10% Administrative Fee Received By djb Check Number Batch Number Authorization Number Paid By BRUCE WIECHERT CUSTOM 000268 080539 City of Springfield Official Receipt'. Dc\'Clopment Serviccs DcpartmcJit ]'ubJic 'Yorks Department Date; U1/U6/2UU4 10:34:57 At\1 Amount Paid Item Total: 8.00 1,000.00 50,00 75.00 75.00 35.00 (30.00) 889.00 452,80 344.20 164.89 727,42 21423 10.00 IOL92 53,94 314.63 695.65 254.00 12,00 18.00 9.00 6.00 6,00 4.00 15.00 10.00 59.00 106.00 38.00 84.96 121.37 $5,925.0 I . . How Received In Person Payment Total: Amount Paid $5,925.01 $5,925.0 I CITY OF S!NGFIELD SYSTEMS DEVELOPMEN_ORKSHEET JOURNAL OR JOB NUMBER: Com2003-01238 NAME OR COMPANY: Custom Homes LOCATION: 4042 Douglas Drive TAX LOT NUMBER: 1802061 I tll 1600 DEVELOPMENT TYPE: SINGLE FAMILY RESIDENCE NEW DWELLING UNITS I BUILDING SIZE (SF: 1872 LOT SIZE (SF): I. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS SF x I COST PER S.F, CHARGE I 3065.50 $0,290 I = I $889.00 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS I IMPERVIOUS SF I x I COST PER S,F, I x I DISCOUNT RATE I I DISCOUNT 0.00 I $0,290 I I 50% = I $0.00 ITEM I TOTAL - STORM DRAINAGE SDC $889,00 2. SANITARY SEWER - crr'( 5850 r/J ~ o o u ~ ~ r/J ~ Cj ~ $889,00 11070 A. REIMBURSEMENT COST: I NUMBER OF DFU's I x I COST PER DFU 20 I $22.64 $452.80 1091 B. IMPROVEMENT COST: I NUMBER OF DFU's I x I COST PER DFU 20 I $17.21 5344.20 1092 ITEM 2 TOTAL - CITY SANITARY SEWER SDC = , 5797.00 3. TRANSPORTATION A. REIMBURSEMENT COST: I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIP FACTORI 9.57 I I I I $17.23 I 1.00 I $164.89 11093 B. IMPROVEMENT COST: I ADTTRIPRATE I x I NUMBER OF UNITS I x I COST PER TRIP x INEWTRIP FACTORI I 9.57 I I I I $76.01 I 1.00 $727.42 1094 ITEM 3 TOTAL - TRANSPORTATION SDC = I $892,31 , 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUMBER ~F FEU's I x ICOST PER FEU I $314,63 = $314.63 , 1054 B. IMPROVEMENT COST: INUMBER ~F FEU's I x ICOST PER FEU $214,23 = 5214.23 I 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 I 1054 MWMC ADMINISTRATIVE FEE $10.00 I 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDl = , $538.86 I SUBTOTAL (ADD ITEMS 1,2,3, & 4) ~ , $3,117.17 J ~. ADMINISTI{ATIVE FEE: I ISUBTOTAL I x I ADM. FEE RATE r I CHARGE I $3,117.17 I 5% $155.86 TOTAL SANITARY ADMINISTRATION FEE: 101.92 1079 TOTAL TRANSPORTATION ADMINISTRATION FEE: $53.94 1078 Virginia Jurasevich 12/26/2003 TOTAL SDC CHARGES = $3,273.03 l PREPARED BY DATE . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTURES x UNIT EQUIVALENT = DRAINAGE FlXTURE UNITS (NOTE' FOR REMODELS, CALCULATE ONL V THE NET ADDITIONAL RXTURES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS BATHTUB 1 0 3 = 3 DRINKING FOUNTAIN 0 0 1 = 0 FLOOR DRAIN 0 0 3 = 0 INTERCEPTORS FOR GREASE / OIL 1 SOLIDS 1 ETC 0 0 3 = 0 INTERCEPTORS FOR SAND / AUTO WASH / ETC 0 0 6 = 0 LAUNDRY TUB 0 0 2 = 0 CLOTHESW ASHER / MOP SINK 1 0 3 = 3 CLOTHESW ASHER - 3 OR MORE (EA). 0 0 6 = 0 MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRIG 1 WATER STATION / ETC. 0 0 1 = 0 RECEPTOR FOR COM, SINK / DISHWASHER 1 ETC 0 0 3 = 0 SHOWER, SINGLE STALL 1 0 2 = 2 SHOWER, GANG Q'lUMBER OF HEADS). 0 0 2 = 0 SINK: COMMERCIAURESIDENTIAL KITCHEN 1 0 3 = 3 IS INK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASIN/DOUBLE LAVATORY 1 0 2 = 2 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 1 0 1 = 1 I URINAL, STALL! WALL 0 0 5 = 0 ITOILET, PUBLIC INSTALLATION 0 0 6 = 0 ITOILET, PRIVATE INSTALLATION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 20 .EDU (Eauivalent Dwellin~ Unit) !!.! discttarae eauivalent to a single family dwellin~ unit (20 DFU's) set al 167 ~lIons per day MWMC CREDIT CALCULATION TABLE: BASED ON COUNTY ASSESSED VALUE L YEAR CREDIT RA TE/$I,OOO 'j I ANNEXED ASSESSED VALUE IS LAND ELGIBLE FOR ANNEXATION CREDIT? 0 I BEFORE 1979 $5.04 (Enter I for Yes, 2 for No) ,I I 1979 $5.04 IS IMPROVEMENT ELGIBLE FOR ANNEX. CREDIT? 0 I 1980 $4.95 (Enter I for Yes, 2 for No) I 1981 $4.88 BASE YEAR 1979 I 1982 $4.75 I 1983 $4.58 CREDIT FOR LAND (IF APPLICABLE) I 1984 $4.41 VALUE /1000 CREDIT RATE I 1985 $4.20 $0,00 x $5.04 ~ I $0.00 I 1986 $3.88 I 1987 $3.S0 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) I 1988 $3.07 VALUE/IOOO CREDIT RATE I 1989 $2.60 $0.00 x $5,04 0 I \990 $2.14 I \99\ $1.11 I 1992 $1.52 TOTAL MWMC CREDIT = $0,00 I \993 $U8 I 1994 $1.19 I 1995 $\.03 I 1996 SO.87 I 1997 SO.68 I 1998 $0.46 I 1999 $0.27 I 2000 $0.09 11 2001 $0.04 I . ~\,\,'r.1 \O~~f::J0 ~e 0 .,~,~'" 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-368:",,~:~~~Q~ ELECl'RlCAL PERMIT APPLICATION .O,00~O' ,0 V City Job Number LojA1 z,ooJ - 0 I 2.-3 E' Date ,;.\""~00' ,,\\0 (;\0 \0 ~ ..,._" '-v.;: ./-.---.., ':'-'-''W!.; "."~~'" , . , 8,',(')l:1' i<i' ~\.::; c...\~(:\. ....'....'l':;""~il\m!'!iW!i ,Jti.~.;' e~ i1r:llin \i!!!~ CITY OF S: ,1NGFffiLD, OREGON ,':, 200 Amps or less $ 63,00 201 Amps to 400 Amps $ 75.00 401 Amps to 600 Amps $125.00 601 Amps to 1000 Amps $163.00 O~er 1000 Amps/VoI~oU \~\'j $375.00 Reconnect ~\)\leS {\ U\\\\ l\ $ 50.00 Ia.'l'l ~ eQ,o i\, \0 'I/7Lf-S ~~~~~e11f~~~ ~~ 1\0 &009 ~~oS ~~ ~e II) e p..~..... IU\es e-lJlil!~~OA1~JI1lo1ll'0~a~l'n \OI~~\~&\\O~'2.~~~&rq;, \~e ~O\\~\c3\\o I $ 50.00 5'0 ~0~f'.~95 ~~IO~~~!f~s'.'>b.b."\. $69.00 , 90."iOU \~do:t<l~~~P~' $100,00 ~O ~\\{\9 \~e. \lo(\ .:.~ al \<ll5vtr,600 Kmps or 1000 Volts see "B" above, ~'O lil'ii1!(ij,"i:j,"""-'~~~_ {\\) OC~~e~~ New Alteration or Extension Per Panel One Circuit Each Additional Circuit or with n ," w- . \^- 1. C I__!L... Service or Feeder Permit Owners Name' ..., "(oJ <-<::.- \ e C/V ~ y T vS7V"" ITUY" ~ '3 ' 1.fi\\'r;~~~~~i=.'~Jll'~-'li!!!ft\';1'il"'\lr"'''!'SI Address ?, '7 S- P '^" IL 1+; \\~ E. ~~_~_.""'~~! 'r(w~l!!~"...e,)!l!!rl!~ City Evr.pnp. Phone bg{'-9Lf5~ PumporirrigatiXt.'j..,?\\\~~\\\tI\\ \~~ $50.00 .J ~\)1~~~~~h't\\'2l\DC)~t.1J t\)I' $ 50.00 OWNER INSTALLATION \'t\\~~e,;~t~~ $ 25.00 The installation is being made on y__yo,,/ I own which Jl>1j~~~ercial $ 45.00 is not intended for sale, lease or rent MiQi~I'h~'~~~:":;~nspection Fee is 545.00 + Surcharges ,~\~.) 4, tsm~iti'~i~ I 7/..{ 7% State Surcharge . I 3. ::>'8 10% Administrative Fee I 9' I{ 0 'Z 'Z b~ 1. 0.:006;4\-, 'OMeEjJNj-:-;A'i:r;Wii1lQ~~ 1 ~-""" ,'El' .~"'. -"~,.",,,..~jiijj"" . 701-/2 \)OIJJ\o-.S ~v LEGAL DESCRIPTION I f5 O,?-O ~ {j II boo JOB DESCRIPTION >rCL. 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. Electrical Contractor lie EI.pI'Jrrc.. J(JfU.5 Auo eel Address f;J95,~ City 'So ~I d Phone <133 -JS9E3 Supervisor License Number Expiration Date IO-()I ~OLf. Expiration Date 1054 "7S :5 - iO -olf Constr. Contr. Number Sign~/uP71:ol . Owners Signature: Inspection Request: 726-3769 3. A. 1i\N~.IR'"ilitfttir.i=rSi'~ i~ 011 ~. ~b"""'"'''' 'l Service Included / tJ:? 3.8 1000 sq, ft. or less Each additional 500 sq. ft. or portion thereof I L $ 19.00 $106,00 Each Manufact'd Home or Modular Dwelling Service or Feeder B.ILW.#~d!P$i'a1. "rr;~. .", ,~J&'g' --;: - !);fJ,li. - j!:Q-:..iJl i...il' ' ",', 'A}" , $50.00 $ 43.00 $ 3.00 TOTAL Shared Drive(T:)IBuilding FormslElectricat Permit Am>ticalioo 1.o3.doc