HomeMy WebLinkAboutPermit Building 1995-4-18
LOCATION OF PROPOSED WORK: ~99/
ASSESSORS MAP: /~ ~2.....c5 y~
/"3
.::?/.~ b'~~.D ~~E)-,
ADDRESS: h "70 7}~- &. .
.. ,
/~~
- / -
RESIDENTlAi:-:---'
PERMIT APPLICATION
-.
-....,.-~.
Inspections: 726.3769
Office: 726.3759
LOT:
OWNER:
CITY'
~?3
t:l'A:;r..., ~~~
, . -
SPRINGFIELD
~79/.#"'#
BLOCK'
STATE: '
DESCRIBE WORK: ~?"~;/~ .~~
NEW
REMODEL
ADDITION
DEMOLISH
, OTHER
. 'H:_~~~~.- ~,I \.~
JOB NU;:;SER q <Q!l2~ '\
225 Fifth Street
Springfield. Oregon 97477
TAX LOT' ~ .:::s:?~
SUBDIVISION: .~~A/6"""CY"",,,,,,,,,,,,,c.~:-"
PHON'"
4'7'7 -B??2.
ZIP:
"7/'-7"26
~""5"~~~
CON ST.
CONTRACTOR #
CONTRACTOR'S NAME ADDRESS
GENERAL: JY~~. j ~~--:-
. y, Plll/uh;';;'
PLUMBING:~~' ~~
MECHANICAL:~.:--:.j-' ~
ELECTRICAL: ~~/ &? - 13f1 J.J..r1'p
, ,..~-
,
.........
QUAD AREA: ~f-7~ f' -,.
I
€"Ih
I
WATER HEATER: _f'.,
'OF BLDGS:
OCCY GROUP:
. OF STORIES:
EXPIRES
PHONE
?<y~"S2 .~-~</-?T 7'-5' ~-B ;;;;-='
O1lfd.8 r -"1 h/ c,C:; f,tjL/, /4//),
1..MLt/h l!lrEJ/C,r;' md~ !J)tf-fl
';';:;01 tf/..M/'f5' ~t'1, / t5'1
- OFFICE USE -
LAND USE:
# OF ur-JITS'
IlU
I
Vf\1
FLOOD PLAIN'
ZONING CODE: ~Dr2-
?]
# OF BDRMS:
SECONDARY HEAT: -
SQUARE FOOTAGE:"' 11:J~>
To request an Inspection, you must call 726-3769. This Is a 24 hour recordIng. All InspectIons requested before 7:00 a.m. will be
made the same working day. Inspections requested utter 7:00 a.m. will be made the (ollowlng work day.
)
o Temporary Electric
~
D
Site Inspection - To be mado
after excavation, but prior to
setting forms.
o Underslab Plumbing/Electrical/
Mechanical - Prior to ,cover.
"
~~oot1ng - After trenches are
excavated.
o Masonry - Steel location, bond
beams, grouting.
[~rFoundatlon - After. forms are
erected but prior to concrete
placement.
D Underground Plumbing - Prior
to filling trench.
W Underlloor Plumbing/Mechanical
- Prior to Insulation or decking.
[]2J/post and Beam - Prior to floor
Insulation or decking.
,
.
ffi~'oor Insulation - Prior to
decking.
[]1' S,anitary Sewer - Prior to filling
trench.
; .\
~Storm Sewer - Prior to filling
trench.. ....
j '...
[i2( Wat~~"[Ine - Prior to tilling
trench. .
..
i~OUg~ Plum~.ing..- Prior to
. . cover. ~
CONSTR. TYPE:
HEAT SOURCE: ~/?P,
[ -
RANGF'
REQUIRED INSPECTIONS
~ough MechanIcal - Prior to
cover.
~OU9h Electrical - Prior to
cover.
/
r-YElectrlcal Service - Must be
l...&LI approved 10 obtain permanent
electrical power.
o Fireplace - Prior to facing
. materials and framing Insp.
[kt'framlng - Prior to cover.
~,WaIl/C'elllng Insulation - Prior to
l...f7d cover.
Ga'Drywall - Prior to taping.
o Wood Stovo -' After Installation.
D Insert - After fireplace approval
and installation of unit.
ffiurbcut & Approach - After
forms are erected but prior to
placement of concrote.
~dewalk & Driveway - After
excavation Is complete, forms
and sub.base material in place.
o
Fence - When completed.
o
Street Trees - When all required
trees are planted.
-',
/
W Hnal Plumbing - When all
plumbing work Is complete.
, ,
,..
1""
~Inal Electrical - When all
electrical work Is complete.
~Flnal Mechanical - When all
mechanical work Is complete.
~al Building - When all
required inspections have been
approved and building is
completed.
DOlher
MOBILE HOME INSPECTIONS
"
o Blocking and Set.Up - When all
blocking Is complete.
o Plumbing Connections - When
home has been connected to
waler and sewer.
o Electrical Connection - When
blocking, set.up, and plumbing
Inspections have been approved
and the home Is connected to
the service panel.
----
o Final - After all required
Inspections are approved and
porches, skirting, decks, and
ventlng have been Installed.
r
Lot taces
Lot sq. Itg.
Lot coverage
Topography
''1'
Total height ....l...:-
f gi')
\ -
BU!LDING PERMIT
ITEM SO. FT.
1~'60.
446
Main
Garage
Carport
Total Value
Building Permit Fee
State Surcharge t-3C/t)
Total Fee
'.
Panhandle S
Cul.de.sac'-'-. -~ _=~
Lot ~ype.
v: Interior
Corner
p.L.
N
X, $ ISO, FT. =1ffIitA E
30.2.0.
J4.IC\',
(A)
}R~~
~4~
SYSTEMS DEVELOPMENT CHARGE (SDC) Jh
u, 'Ie ~
(B) W 2U>4-
PLUMBING PERMIT
ITEM
Fixtures
Residential Bath(s) N'
Sanitary Sewer FT.
Water
Storm,S"e;;:'er
Mobile Home
Plumbing Permit
\"
State Surcharge
Total Charge
FT.
FT.
rfJ
MECHANICAL PERMIT
(C)
Furnace
Exhaust Hood
Vent Fan
N'
~
Wood Stove/lnsertl FIreplace Unit
Dryer Vent
Mechanical Permit
Issuance
State S,urcharge
Total Permit
(D)
Moblte Home
MISCELLANEOUS PERMITS
State Issuance
State Surcharg,...,
Sidewalk I p -:> fl
Curbcul \...'in ft
Demolition
Slate S~rcharge (\ ()
\ ob..O.t\ A-\00O...Q V".
FEE
f11j)OJ
J1o{ ) ~
~?f)
/j{), H.J
(()~
4.5)
ypo
....~.CD
~)}.~
IOr;v
\. ~\
3'1.~L
1C1.45
/4 .-!25()
J){J.W
Tolal Miscellaneous Permlts (E)
TOTAL AMOUNT DUE (excluding electrlcal~rl'::::> .Iot
(A. B, C. D. and E Combined)
; ~ .' ;:':
'.:,.
:,1 <.
'-5 THE PROPOSED WORK IN THE
""HISTORICAL DISTRICT, OR ON '\;
THE HISTORICAL REGISTER?
If yes, this application must be signed
and approved by the Historical
Coordinator prior to permit issuance.
Setbacks
HSE GAR
ACC I
I
I
APPROVED'
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
ThIs permit is granted on the express condition that the said
construction shalf, In all respects, conform to the Ordinance
adopted by the City 'of Springfield, Including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any lime
upon violation of any provisions of said ordinances.
~~
Date Paid: ,3'''"'~~
Receipt Number:~~~
-r-----
Plan Check Fee:
Received By:
Plans Reviewed By
Date
Systems Development Charge is due on all undeveloped
properlies within the City limits which are being Improved.
AD9ITlONAL Cg.MMENT~
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f11t J1J (i1J _
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r)H1ot?lu ;'
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By signature, I state and agree, that I have carefully examined
the completed application and do hereby certify that all
Information hereon Is true and correct, and I further certify
that any and all work performed shall be done in accordance
with the Ordinances of the City of Springfield, and the Laws
of the State of Oregon pertaining to the work described
herein. and that NO OCCUPANCY will be made of any
structure without permission of the Building Safety Division.
I further certify thaI only contractors and employees who
are In compliance with ORS 701.055 will be used on this
project.
I further agree to ensure that all required Inspections are
requested at the proper time, that each address Is readable
from 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. ~07'fctjO~
Signature ~~
Oato
q ~F/'f5
VALIDATION:
RECEIPT NUMBER / 7 DOz..
DATE PAID ~~~ A .
'MO"" "'c""~. rr3f::f'1.-1
RECEIVED BY ___~~~
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CITY OF SPRINGFIELD
COMMUNITY SERVICES DIVISION
BUILDING SAFETY
AUTHORIZATION TO PROCEED AGREEMENT
THIS AGREEMENT is entered into this:1 day of ~ 1-
between the City of Springfie:dOr mun~ll~a~.iorporation of
hereinafter called Ci ty, and ~\\ "\Uf...J.lLl.]J \ ~O [\./
the Applicant. - - -
YHEREAS, the applicant has applied to the City Community Services Building
Division for issuance of certai~l1~s\tr~ion pe its for development
improvements to be located at ~~ ~~ \ ) Springfield,
Oregon or wi thin the Ci ty' s Urban Growth . s ' , - 9;}i\-h~j" ea; Lane. Coun ty
Assessor's Map and Tax Lot number 1/>11 I
, 19'iF by and
the State-oI Oregon,
, hereinafter called
YHEREAS, the applicant has asked the City to authorize the Applicant to
immediately commence development improvements without a completed plan review or
subsequent approval as required by the Springfield Building Safety Code
Administrative Code section 303(a).
YHEREAS, the Applicant has submitted to the City a completed permit application,
3 (three) sets of construction drawings, specifications, and other data required
for the City to complete the necessary plan review of the proposed development
improvement.
YHEREAS, the intended development improvement is of a nature that requires no
other review approval from other State or local agencies and is exempt from the
criteria established by the Building Safety Division, attached as Exhibit A of
this Agreement.
YHEREAS, the City has not reviewed or approved the submitted materials for the
development improvement, the City is therefore unable to confirm at this time
whether the permit applicatic~ submitted will be approved, and whether the
~equired construction permits can be issued.
.
YHEREAS, the applicant has requested the City to provide expedited authorization
to proceed with certain phases of construction prior to the completion of the
City'S review of the permit application.
YHEREAS, the City's fee for the administrative services rendered in providing
expedited authorization is $150.00.
...
NOY, THEREFORE, in consideration of the foregoing recitals and of the mutual
promises contained herein, the City authorizes immediate commencement of the
development improvement specified in the permit application subject to the
following terms and conditions:
v .
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Authorization to Proceed Agreement
Page 2.
1. City agrees that the Applicant may immediately commence with the
development improvements set forth in the permit application. City's
authorization to proceed is conditionep however, upon Applicant's agreement
that the project will be constructed as set forth in the attached submitted
drawings and specifications, except as may be modified' by City, and will
comply with all applicable laws and ordinances. Applicant's immediate
commencement of construction is at Applicant's own risk. The City makes no
assurance that the development or construction improvements viII be approved
or the required construction permits viII later be issued.'
2. City agrees to review Applicant's permit application in the normal review
process and to thereafter: .
a) issue Applicant the appropriate construction permits; ~
b) advise Applicant of deficiencies in the proposed construction which
must be remedied before permits can be issued; ~
c) advise Applicant of any statutes, ordinances or code provisions with
which Applicant must comply with before- City can issue the permit.
3. Applicant agrees that if City finds Applicant's permit application and
submitted materials inadequate or deficient in any manner including but not
limiteQ to, the application or the proposed construction do not comply with
all applicable statutes, ordinances or code provisions, Applicant will
expeditiously cure the deficiencies so that the City may issue the required
permits. Should Applicant fail to expeditiously correct submitted materials,
or should correction prove impossible, City may in it's discretion, take any
or all of the following actions:
a) stop all further construction of the project in the manner prescribed
in the Springfield Building, Safety Code Administrative Code (BSCAC),
SECTION 201 (d)
b) order disconnection of serving utilities in a manner as prescribed in
BSCAC, SECTION 201 (f)
c) issue a NOTICE ~'J ORDER for removal of all such ~ork in a manner as
prescribed in BSChC, SECTION 204. ABATEMENT Or UNSAFE, SUBSTANDARD OR
DANGEROUS BUILDINGS, STRUCTURES OR BUILDING SERVICE EQUIPMENT. Upon
receipt of such notice, Applicant shall immediately remove the work
specified in the Notice and Order.
4. Applicant agrees, if the issuance of the permit is denied:
.
a) to remove, at the Applicant's sole cost and expense, all completed
construction or improvements; and
b) to restore the site or structure to it's pre-agreement condition and
free of all hazards
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Authorization to Proceed Agreement
Page 3.
5. Applicant agrees that until hpplicant.s permit application is approved,
construction viII not to proceed beyond the point of authorization approved
by the City's Building Off~fial. Applicant's Point of Authorization is
, r\OC\Y . nA"'{ ---:
6. Applicant agrees that a;l vO;k p~rfJrmed under this agreement shall ~e
accessible and exposed for inspection purposes and that neither the Building
Official nor'City shall be liable for the expense entailed in the removal or
replacement of any material necessary to allov inspection.
7. Applicant agrees that any or all'deficiencies identified during the
necessary inspections viII be promptly remedied, at Applicant's sole cost
and expense before proceeding vith any further construction. Applicant also
agrees that these inspections do not replace the required plan reviev nor do
they imply any approval of the submitted materials.
8. Applicant agrees that no vork shall be done on any part of the building
or structure beyond the point indicated in each successive inspection
vithout first obtaining the approval of the Building Official. Such approval
shall be given only after an inspection has been made of each successive
step in the construction as indicated on the attached Exhibit B.
9. Notvithstanding any other provisions of this Agreement, this Agreement
shall terminate upon issuance of a building permit or thirty (30) days from
the date of this Agreement, vhichever first occurs. Applicant understands
that all vork on the project shall immediately cease vithout any notice from
the City if this Agreement terminates before a building permit is issued.
This agreement shall teminate on ~L 2. 7, . /71'r
,
10. Applicant agrees to defend, indemnify and hold City harmless from any
and all costs (including attorney fees), liability or damages of any kind or
nature vhatsoever, for personal injury and property damage arising from the
Applicant's early commencement of construction and the vork undertaken or
completed.
11. The terms of this Agreement shall extend to and be binding upon the
parties hereto and t:,eir heirs, successors and assigns.
,
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12. If any suit, action or other proceeding, or an appeal therefrom, is
instituted to obtain, establish, enforce, or compel any right or obligation
resulting from this Agreement, the prevailing party shall be entitled to
recover from the adverse party, in addition to costs and disbursements, such
additional sums as the courts, both trial and appellate, may judge
reasonable attorney fees.
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Authorization to Proceed Agreement
Page 4.
BEFORE SIGNING THIS AGREEMENT, PLEASE READ AND UNDERSTAND THE MEANING OF EACH
PARAGRAPH OF THIS AGREEMENT. IT AFFECTS YOUR INTERESTS IN THE PROPERTY AND, IN
THE EVENT ,OF DEFAULT, IT PLACES YOU PERSONALLY AT RISK AND THE SUBJECT PROPERTY
AT RISK OF FORECLOSURE FOR COSTS AND EXPENSES INCURRED BY THE CITY IN ENFORCING
THE TERMS OF THIS AGREEMENT. IN THE EVENT THAT YOU DO NOT UNDERSTAND ANY TERMS
OR CONDITIONS OF THIS AGREEMENT, PLEASE SEEK ANY LEGAL OR OUTSIDE OPINIONS YOU
MAY.DESlRE.
CITY
" APPLICANT
City of Springfield
~y:~Z~~_ .~
Building Official
Contractor ~~ ~OOlO f)
Business r\~{i!~ ~~,)~~ <t:f)m~
Address\)!\J~.:) ~~~
CC Registration # ~~~,~
LANDI PROPERTY OVNER(S)
I/YE HAVE READ THE ABOVE AUTHORIZATION TO PROCEED AGREEMENT. I/YE UNDERSTAND
YHAT IT EXPRESSES AND THE RESPONSIBILITIES IT PLACES UPON US AS THE
LANDI PROPERTY OYNERS. I/YE AGREE TO BE BOUND BY ALL TERMS AND CONDITIONS OF THE
AGREEMENT.
Name ~ rfAd
Address 'C; 70 p::y"",,(. c..r ~s~~ ~.e.
,
~
. EEVlE\'.Jt=::C, [L p.P?r~C'VcD
f~,\ TO FCiF:f\1 \
_..j~?~~\-'..J LrU-'\....I_
C!:,E: ~~ \q \V\~
Cr:Fi~:.: C~ CITY ATTORf\~EY
C~-!-\.' ;~':' ~<~;:;1:<2:=E=LD
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EXHIBIT A
Purpose
The purpose of this agreement is to allow 'certain development improvements to
occur prior to obtaining plan review approval from the Springfield Community
Services Division.
Scope
The use of this agreement shall be limited to certain one and two-family
dwellings not complex in nature as determined by the Building Official and
minor alterations or modifications to existing commercial and industrial
buildings which are of a non-structural"type and do not adversely affect any
structural member of the building or any part of the building having fire
resistant construction.
One and two-family dwelling plans for structures that are complex in nature that
have been prepared by an Oregon licensed architect or engineer and accompanied
by a letter of review prepared by said architect or engineer, stating that the
submitted material is in compliance with the One and Two-Family Dwelling
Specialty Code, may be considered eligible fo~ this agreement.
The following items include but are not limited to certain conditions of
development identified as ineligible for this agreement:
a) development requiring site approval which has not been obtained;
b) new development located on land with over six-percent slope;
c) lots having expansive (clay) soil;
d) development located within flood hazard areas;
e) development located within wetland areas;
f) pole buildings or other such type of structure that is not of conventional
construction.
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em NO. .q502-~G
CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE
WORKSHEET
(COMMERCIAL & RESIDENTIAL)
.
ATTACHMENT Bl
"
NAME OR COMPANY: f<rVU:" '8eNP J.-/.cME5 - u -----
LOCATION: 4-'f"'1/ n~sY-n-ItA 1<60'2-04-00 - P/o ()'2-Qoo
DEVELOPMENT TYPE' L.IJ!Z- - N e.w SFrz.
BUILDING SIZE:
1. STORM ORA I NAGE
IMPERVIOUS SQ. FT.
lOT SI7F
SQ. Ft.
.",
7-'1 ? 1,-
X SO.209 PER SQ. FT.
C'S-p;, 12)
'-- --'
2. SAMlIARY SFWFR-CITY
NO. OF PFU' S I ox
(See Reverse)
3. TRANSPORTATION
NO OF UNITS X TRIP RATE X COST PER TRIP
X $43.26 PER PFU
C-n~~)
'--- -----'
X
X
X $436.19
X $436.19
C 44053-)
'-- -----
$
/ X ;.01 X $436.19
$
SUBTOTAL (ADD ITEMS 1.2. & 3) $ /1'14 ~
4. SAMlIARY SFWFR-MWMC
NO. OF PFU'S I~ x $17.19 PER PFU + $10 MWMC ADMIN.FEE
(Use PFU Total From Item 2 Above)
MWMC CREDIT IF APPLICABLE (SEE REVERSE)
IQIAI -MWMr. snr.
SUBTOTAL (ADO ITEMS 1.2.3 & 4)
$ ? J "1 ~'Z-
$ 13 'l.:!
($ 1>0'5 ~ )
$..J! ~ Zo <f'1 ~
5. AOMINISTATTVF FFF~
BASE CHARGE (SUBTOTAL ABOVE) X .05
~06~ -;
...... ...----
V:~~Lt.L
-W:- -, :',.. --:.. !' ~
SO( Coordi ~ator - ,
Date: :;/14/"f5
IQIAI SilL
96
$ -2:204- ~
B2.SDC .
'1 . ". :.... ",'.".( __ ~ .-
~1~~~~~e~~e~I C~lt~~~n~~~I_ a~:i~n~~f~x~~r~:,er of New Fixtures .it Eq~tt~i~~;'~"f.~~\J~i~;;:"~'"
NUMBER OF UNIT FIXTURE ..
FIXTURE TYPE NEW FIXTURES EQUIVALENT UNITS
,..
2
1
2
3
6
2
6
6
1
3
2
1/Head
2
2
1
6
4
t/-
Bathtub..................................................................... .
Drinking Fountain.................... ~................ ................
Floor Drain............................................. ...................
Interceptors For Grease/OiI/Solids/Etc.................
Interceptors "For Sand/Auto Wash/Etc.................. .. '
Laundry Tub/Clotheswasher.... .,............. ........ ........
. .. ..' .
Clotheswasher - 3 Or More..............~................;;.~:..
Mobile Home Park Trap (1 Per Trailer)..................
Receptor For Refrigerator/Water Station/Etc........
Receptor For Commercial Sink/Oishwasher/Etc..
Shower. Single Stall.................................................
Shower, Gang............................... ....................:.,....
Sink: Bar, Commercial. Residential Kitchen...............;,.......
Urinal. StalliW all............... ................................... .';.....
Wash Basin/LavatorY. Single..................................
Toilet. Public Installation........................................
Toilet . Private...................................................:...
Miscellaneous:
,'2-
z.
z.
--t.-
'l-
51
TOTAL FIXTURE UNITS
I'i.
CREDIT CALCULATION TABLE: Based on assessed value. If improvements occurred after annexation date in table,
calculate credits separates.
Year
Annexed
Rate per $1.000
Assessed Value
Year
Annexed
Rate per $1.000
Assessed Value
1979 or before
1980
19S1
1982
1983
1984
:1985
$3.46
3.38
3.32
3.21
3.06
2.92
2.73
1985
1986
1987
1988
1989
1990
1991
1993
$2.46
2.14
1.77
1.37
0.97
0.61
0.44
0.15
Improvement (if alter annexation date)
?1.4-h X $ 4-.0
(Rate X Assessed Value)
X $
(Rate X Assessed Value)
=
1'5 . rftf
Credit 'for Parcel or Land Only If Applicable
=
CREDIT TOTAL
, g4
= $ 1'3 ..:---
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lob No. ant) ~ g&
SYSTEMS DEVElOPMENT CHARGE
WORKSHEET
NAME; .&ill Bu1J1 ?={:n.mIs
.
ADDRESS: LJq41 ~ y'~r a /
PHONE: q6 4- ~~ 2..
STATE: ~ ZIP Jf1!J1~
, '
LOCATION OF PROPOSED BUILDING SITE: .
Street Address if Known: Ll44' -r:;, Vt7~/.l;
Platt Name: ~ I~D.p (r,,\ r.d(f, Tax Lot Number: 1$ (/UJ4<X) ~
1. DEVELOPMENT TYPE (Check appropriate dwellirig(s). SDC Calculations and dwelling type
definitions are on the back.) , " '
A. Sinl!ie Familv - Oetached
Single Family home
NO OF UNITS I
B. Sinl!le Familv - Attached
NO OF UNITS
C. Multi-Familv Aoartment
NO OF UNITS
D. Manufactured Home Park
NO OF UNITS
Manufactured home not in a park
X $400 PER UNIT _= $tkt>. t:O
.
X $370 PER UNIT =
'$
X $777 PER UNIT =
$
X $280 PER UNIT =
$
WPRD SDC
$..JiM. (JO
$.:ff
$ lUJO. (JO
2. SDC CREDIT (If applicable) SDC-payer must furnish proof of WPRD Credit
approval. See sac Credit Worksheet.
3. TOTAL WPRD NET SDC ASSESSED (If SDC reduced for Credit!
~L~
~ I 13 I '16"
Date
rf"lmmllnitv ~p.r"jV~ njvi~i()n
\
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. ubmitled has the iollm.. -
1he following prol8C\ ~:qS uirs specific land use
zoning, and does no
approval.
225 FIFTH STREET
SPRINGFIELD, OREGON 97477
INSPECTION REQUEST: 726-3Vi6'!}
OFFICE: 726-3759
ZonIng
Authortzad Signature
1. LOCATION OF INSTALLATION
'<-/99 I /o/P <; t /77-1/4
LEGAL DESCRIPTION
-)-0 T #/3 /.JISfltJ;P As774RS
JOB DESCRIPTION
/4A-J/). P(}.{d,(J ,f'OL'C
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
, _ .".u .~'contractork?iVc.4 /30dJ,fhy,(!,
Address
(J.W N4(
City
Phone
Supervisor License
~^,.."::>.--~
Number L/ ( '~~ -
." If" ~
'-/If/~7
Expiration Date
Constr Contr. Number ~rC)'':::2.
Expiration Date /J)~,"'3~
Signature of Supervising Electrician
\
Owners Name rf!./VCt(:! I8Cc'1"o !/ttJ1.r0 J:;u(..
Address C; 1';0 PI X/[ c..r
Ci ty CI!t;:.Stuy-L. L Phone. 9'5//-8332..
OIINER INSTALLATION
The installation is being made on
property I own which is not intended
for sale, lease or rent.
;wn~l2L
---------------------------------------
DATE: -=3~--9?'
RECEIPT I: . /~ ~ -;:2 /
RECEIVED BY: ~...J"J-'- ~
ELECTRICAL PERMIT APPLICATION
City Job Number 9~2pr
3. COMPLETE FEE SCHEDULE BELOII
A. New Residential-Single or
Multi-Family per dwelling uni t.
Service Included:
It ems Cost . Sum
1000 sq.ft. or less $ 85.00
Each additional 500
sq. ft or portion
thereof $ 15.00
Each Manuf'd Home. or
Modular, 'Dwelling
Service or Feeder $ 40.00
,B. Services or Feeders
Installation, Alterations
or Relocation:
200 amps or less
201 amps to 400 amps
401 amps to 600 amps
601 amps to/1000 amps
Over 1000 amps/volts
Reconnect Only
$ 50.00
$ 60.00
$100.00
$130.00
$300.00
$ 40.00
C.
Temporary Services or Feeders
Installation, Alteration or Relocation
200 amps' 'or less
201 amps to 400 amps
Over 401 to 600 amps
Over 600 amps or' 1000
---$ 40.00 '7'z7
$ 55.00
$ 80.00
volts see "B" above
D.
Branch Circuits
.'
New, Alteration or Extension Per Panel
One Circuit
Each Additional
Circuit or with Service
or Feeder Permit
$ 35.00
$ 2.00
E. Miscellaneous (Service/feeder not included)
-Each installation
Pump or irrigation $ 40.00
SignlOutline Lighting $ 40.00
Limited EnergylRes $ 20.00
Limited Energy/Comm $ 36.00
5. SUBTOTAL OF ABOVE 40~ ~
5% State Surcharge . '7_-='
3% Administrative Fee /- 2.t::>
TOTAL ~ ?..-::>
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