HomeMy WebLinkAboutPermit Building 2003-5-23
_CITY OF SPRINGFIJ'..blJ
Building/Combination Permit
PERMIT NO: COM2003-00331
ISSUED: 05/23/2003
APPLIED: 05/02/2003
EXPIRES: 11/23/2003
VALUE: $ 192,605.00
.-
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4696 Ivy St
ASSESSOR'S PARCEL NO.: 180205\304800
Springfield TYPE OF WORK: Single Family Residence
4
Ye~Q~'i-
% of Lot Coverage: Co \r 1I2\'iiO ~ ~Q\
j..,?\~"t. n~\\ ~
-: t I \ 't: r 0\" - d\~
I PUBLl(liMf.~~~Mj~\ ~~~\)Q~t.c, -
F U I dW\~";'Q~\'Lt.~; 'U~ \;)!r- Sidewalk Type:
u y mprove \>.'0 \" ~c.\.ov ~~\vv'
No c.'UW-W-'i:: \)\l-i'? Downspoutsmrains:
\I-~i \'O'U
TYPE OF USE:
PROJECT DESCRIPTION: SFR - same as COM2003-00330 4689 Ivy St
Owner: MARGOLIS FAMILY LTD PARTNERSHIP
Address: PO BOX 5442 EUGENE OR 97405
I CONTRACTOR INFORMATION I
Contractor Type
General
Electrical
Mechanical
Owner
Plumbing
License
109780
99579
133733
Contractor
LARRY KENT COOPER
DEANS ELECTRIC
DEAN M SCHULTZ
MARGOLIS FAMILY LTD PARTNERSHIP
DENNIS SCOTI EGGERS
142776
I BUlLDlNG.INFORMA TION I
-,0" ~ .,,1
-~ ....\\'''l v
# of Buildings: I .\,~#~or.Stories:~' I
0.."" r:\' "'\V,,
Primary Occupancy Gronp: R-3,:\ ~0 ~t!:'-eigh!,'of StrJldnre 19.00
Secondary Occupancy Group: ~;b\'3' 'S'00 IYPt?_~'H~:;O'Forced Air Elect
Primary Construction Type .O~tVNo '0'1 0 ~o,)\E'~.ter !.ype: ~0 Electric
Secondary Construction Type:'~' '>"0,,\0 .<~o<:> ~C),\"Rang[TY:p'eP .\O~ Electric
-,''-' u ,\" \ ~O - V ,-.. ~,
# of Bedrooms: <'.~ ,.,,,,'3' ~e3' r::J'S' ,,~EilergjlPath:' Path 1
:(.'<- ~~lu C0(C'. ~r::J'\. c,0\" ..'S''' ~O\,.
~ .,,,-.tl _""~ _(\V _,~~.~,0\0 ...,~\I.'I _ .../l.'r
;0'i.{i'c,;~~,:;~~'I ~{I.\DEVEt;OPMENT INFORMATION I
SETBACKS Crr< ~oo,) 'S'0CJ 0'-' !O"-
\~ 9r::J. .~o. _<'S' .",V
Front yard Setback: r::J<:::i c,~~ ll~<<!.0,.,~\0~ ~ Overlay Dist:
Side I Setback: o,)~'015.00' # Street Trees Rqd:
Side 2 Setback: (C'. 20.00 Paved Drive Rqd:
Rearyard Setback:
Solar Setbacks:
8.00
5.00
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Page I of 4
New
Residential
Expiration Date
11106/2003
06120/2004
02/23/2005
Phone
541-302-5852
541-935-5303
541-767-0626
05/05/2004
541-459-0110
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Impervious Surface Area:
7,421
2,420
616
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
Curbside 5'
Curb and Gutter
-
.. CITY 01' ~r KlNGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00331
ISSUED: 05/23/2003
APPLIED: 05/02/2003
EXPIRES: 11/23/2003
VALUE: $ 192,605.00
Status Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descriotion I
Description
Dwellines
Garaee
Tvpe of Construction
V Wood Frame
Garaee
$ Per Sq Ft
$74.60
$19.60
Square Footaee
2,420.00
616.00
Valne
$180,532.00
$12,073.60
$192,605.60
Date Calculated
05/0212003
05/0212003
Total Value of Project
I Fpp< PiilLI
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Same As $100.00 5/2/03 1200200000000001114
-Mechanical Issuance Fe.... $10.00 5123/03 1200200000000001315
+ 10% Administrative Fee $147.Q9 5/23/03 1200200000000001315
+ 7% State Surcharge $102.96 5/23/03 1200200000000001315
3 Baths One & Two Family $306.00 5/23/03 1200200000000001315
Addressing Assignment $8.00 5/23/03 1200200000000001315
An nexed 2000 $-0.95 5/23/03 1200200000000001315
Building Permit $867.90 5/23/03 1200200000000001315
Curbcut Permit $75.00 5/23/03 1200200000000001315
Dryer Vent $6.00 5/23/03 1200200000000001315
Exhaust Hoods $9.00 5/23/03 1200200000000001315
Furnace - up to 100,000 btu $12.00 5/23/03 1200200000000001315
Not Covered Mechanical $45.00 5/23/03 1200200000000001315
Plan Review - Planning $59.00 5/23/03 1200200000000001315
PW Mult Disc - 2nd Permit $-30.00 5/23/03 1200200000000001315
Residence Wiring 1000 Sq Ft $106.00 5/23/03 1200200000000001315
Residence Wiring Ea AddtI 500 $95.00 5/23/03 1200200000000001315
Sanitary Sewer - Improvement $453.33 5/23/03 1200200000000001315
Sanitary Sewer - Reimbursement $596.43 5/23/03 1200200000000001315
SDC MWMC Administration $10.00 5/23/03 1200200000000001315
SDC MWMC Improvement $34.83 5/23/03 1200200000000001315
SDC MWMC Reimbnrsement $332.86 5/23/03 1200200000000001315
SDC SanitarylStorm Admin $117.08 5/23/03 1200200000000001315
SDC Transpo Admin $49.10 5/23/03 1200200000000001315
SDC Transpo Improvement $709.81 5/23/03 1200200000000001315
SDC Transpo Reimbursement $160.87 5/23/03 1200200000000001315
Sidewalk Permit $75.00 5/23/03 1200200000000001315
Storm Drainage Impervious Area $1,026.48 5/23/03 1200200000000001315
Vent Fan $24.00 5/23/03 1200200000000001315
Willamalane Single Family $1,000.00 5/23/03 1200200000000001315
Total Amount Paid $6,507.79
I Plan Reviews I
Initial Review
05/05/2003
05/05/2003
APP LLH
Paee 2 of4
-
_ CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2003-00331
ISSUED: 05/23/2003
APPLIED: 05/02/2003
EXPIRES: 1112312003
VALUE: $ 192,605.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Planninl! Review
Public Works Review
Structural Review
05/05/2003
05/05/2003
05/05/2003
05/12/2003
05/19/2003
05/22/2003
APP
APP
APP
AJD
DJW
DJB
Same as COM2003-00330 4689 Ivy
St
To Request an inspection call the 24 hour recording at 726-3769. AIl 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.
'Rpn~
I Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
2 Cnrbcut - Standard: After forms are erected but prior to placement of concrete.
3 Footing: After trenches are excavated.
4 Foundation: After forms are erected but prior to concrete placement.
5 Post and Beam: Prior to floor insulation or decking.
6 Floor Insulation: Prior to decking.
7 Shear Wall Nailing: Before covering sheathing with finish materials.
8 Framing Inspection: Prior to cover and after all rough in inspections have been approved.
9 Wall Insulation: Prior to cover.
10 Ceiling Insulation: Prior to cover.
II Drywall: Prior to taping.
12 Final Building: After all required inspections have been requested and approved and the building is complete.
13 Underfloor Plumbing: Prior to insulation or decking.
14 Rough Plumbing: Prior to cover and including required testing.
15 Shower Pan. Prior to covering and including required testing.
16 Water Line: Prior to filling trench and including required testing.
17 Sanitary Sewer Line: Prior to filling trench and including required testing.
18 Storm Sewer Line: Prior to filling trench.
19 Final Plumbing: When all plumbing work is complete.
20 Underfloor Mechanical. Prior to insulation or decking and including required testing.
21 Gas Service: After line is installed and line has been connected to a minimum of one appliance including required
testing. Presure test done at this point.
22 Rough Mechanical: Prior to Cover
23 Final Mechanical: When all mechanical work is complete.
24 Special: See Plan Review and/or Inspector notes.
25 Rough Electric: Prior to Cover
26 Electric Service: Approval required prior to utility company energizing service.
27 Final Electric: When all electrical work is complete.
Pal!e30f4
-
_ CITY OF SPRINGFIELD
Building/Combination Permit
Status
Issued
PERMIT NO: COM2003-00331
ISSUED: 05/23/2003
APPLIED: 05/02/2003
EXPIRES: 11/23/2003
VALUE: $ 192,605.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
By signature, I state and agree, that I have carefnlly 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 ofany structure withont permission of the Community Services Division, BniIding Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will be nsed 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
timest:ingnCo~~t:ctiO~.. ~ '~I )
~AY'--- -;s ~ S- G:Y b3
Owner or Contractors Signature Date
Paee 4 of 4
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
C0M2003-0033I
COM2003-0033I
COM2003-0033I
C0M2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
C0M2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
C0M2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-00331
COM2003-0033I
C0M2003-0033I
COM2003-0033I
COM2003-0033I
COM2003-0033I
COM2003,0033I
COM2003-00331
COM2003-0033I
Payments:
Type or Payment
Check
5/23/2003
.;"':':;',"'LW~~~,.c~. Ii
Wi. ,
.... .....!
:'- ''1'';.''.'',
~ . "-
--'-
City of Springfield
.
Development Services Department
Public Works Department
Official Receipt .'
Receipt #: 1200200000000001315
Description
Addressing Assignment
WilIarnalane Single Family
Plan Review - Planning
Sidewalk Permit
Curbcut Permit
PW Mult Disc - 2nd Permit
Storm 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/Storm Admin
SDC Transpo Admin
Annexed 2000
Building Permit
3 Baths One & Two Family
Furnace - up to 100,000 btu
Vent Fan
Exhaust Hoods
Dryer Vent
Not Covered Mechanical
-Mechanical Issuance Fee-
Residence Wiring 1000 Sq Ft
Residence Wiring Ea Addtl 500
+ 7% State Surcharge
+ 10% Administrative Fee .
Paid By
MARGOLIS FAMILY
1O:55:36AM
Received By
djb
Date: 05/23/2003
Item Total:
Check Number L'onlirm No
How Received
In Person
Payment Total:
Page lofl
Amount Paid
8.00
1,000.00
59.00
75.00
75.00
(30.00)
1,026.48
596.43
453.33
160.87
709.81
332.86
34.83
10.00
117.08
49.10
(0.95)
867.90
306.00
12.00
24.00
9.00
6.00
45.00
10.00
106.00
95.00
102.96
147.09
$6,407.79
Amount Paid
6,407.79
$6,407.79
-
-
cReceipt.rpt
, CITY OF SAGFIELD SYSTEMS DEVELOPMEN~RKSHEET
JOURNAL OR JOB NUMBER: Com2oo3-oo331
NAME OR COMPANY: Margolis Family
LOCATION: 4696lvr SI.
TAX LOT NUMBER: l8020513TL04800
DEVELOPMENT TYPE:
NEW DWELLING UNITS BUILDING SIZE (SF) 0 LOT SIZE (SF):
7406
,~
I'"
w
10
o
I~
'"
6
~
-
I. STORM DRAINAGE
DIRECT RUNOFF TO CITY STORM SYSTEM
.1 IMI'ERVIOUS S.F. x I COST PER S.F. I = I CHARGE I
I 3640.00 I $0.282 $1.026.48 I
RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED m CITY STANDARDS
I IMPERVIOUS S.F. I x I COST PER S.F. I x I DISCOUNT RATE I I DISCOUNT I
I 0.00 I $0.282 I I 50% I = I $0.00 I
ITEM 1 TOTAL. STORM DRAINAGE SDC I $1,026.48 , , $1,026.48
2. SANITARY SEWER - CITY
A. REIMBURSEMENT COST:
I NUMBER OF DFU's I x I COST PER DFU I
I 27 I I $22.09 I = I $596.43
B.lMPROVEMENTCOST:
I NUMBER OF DFU's I x I COST PER DFU I
I 27 I I $16.79 = I $453.33
ITEM 2 TOTAL - CITY SANITARY SEWER SDC = I $1,049.76 I
3. TRANSPORTATION
A. REIMBURSEMENT COST:
I ADT TRIP RATE I x I NUMBER OF UNITS I x I COST PER TRIP I x INEWTRIPFAcroRI
I 9.57 I , I I $16.81 I 1.00 = I $160.87
B.IMPROVEMENTCOST:
I ADT TRIP RATE I x I NUMBER IOF UNITS I x I COST PER TRIP I x I NEW TRIP FAcroRI
9.57 I $74.17 I 1.00 = I $709.81
ITEM 3 TOTAL. TRANSPORT A nON SDC = , $870.68 I
4_ SANITARY SEWER - MWMC
A. REIMBURSEMENT COST:
INUMBER OF FEU's I x I COST PER FEU I
I I I $332.86 = , $332.86
B. IMPROVEMENT COST:
INUMBER OF FEU's I x ICOST PER FEU I
I I I $34.83 I = , $34.83
MWMC CREDIT IF APPLICABLE (SEE REVERSE) = , ($0.95)
I MWMC ADMINISTRATIVE FEE = , $10.00
ITEM 4 TOTAL. MWMC SANITARY SEWER SDC = , $376.74 I
SUBTOTAL (ADD ITEMS 1,2,3, & 4) = , $3.323.66 I
1070
----l
1091
1092
'11093
I
1094
I 1054
1055
1054
1056
5. ADMINISTRATIVE FEE:
ISUBmTAL I x I ADM. FEE RATE 1=
I $3,323.66 I 5% I
mTAL SANITARY ADMINISTRATION FEE:
mTAL TRANSPORTATION ADMINISTRATION FEE:
CHARGE
$166.18
D. Wright
PREPARED BY
5119/2003
TOTAL SDC CHARGES
117.08 j 1079
$49.10 -.J 1078
,
= $3,489.84 I
II
DATE
- -
DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE
NUMBER OF NEW FIXTURES, UNIT EQUIVAlENT = DRAINAGE FlXTURE UNITS
(NOTE: RlR REMODELS. CALCULATE ONLY THE NET ADDITIONAL FIXTURES)
NO. OF FIXTURES DRAINAGE
UNIT FIXTURE
FIXTURE TYPE NEW OLD EOUIV ALENT UNITS
BATHTUB 2 0 3 = 6 -Ii
';
IDRlNKING FOUNTAIN 0 0 1 = 0 ;i
IFLOOR DRAIN 0 0 3 = 0
IlNTERCEPTORS FOR GREASE / OIL / SOLIDS / ETC. 0 0 3 = 0
IlNTERCEPTORS FOR SAND / AUTO WASH I ETC. 0 0 6 = 0
ILAUNDRY TUB 0 0 2 = 0
ICLOTHESW ASHER I MOP SINK 1 0 3 = 3
!CLOTHESWASHER - 3 OR MORE (EA) 0 0 6 = 0
IMOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0
RECEPTOR FOR REFRlG I WATER STATION I ETC. 0 0 1 = 0
RECEPTOR FOR COM. SINK / DISHWASHER / ETC.I 0 0 3 = 0
SHOWER. SINGLE STALL 1 0 2 = 2
SHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0
SINK: COMMERCIAURESIDENTlAL KITCHEN 1 0 3 = 3
ISINK: COMMERCIAL BAR 0 0 2 = 0
ISINK: WASH BASIN/DOUBLE LAV ATORY 1 0 2 = 2
ISINK: SINGLE LAVATORY/RESIDENTIAL BAR 2 0 1 = 2
IURlNAL. STALL! WALL 0 0 5 = 0
ITOILET. PUBLIC INSTALLATION 0 0 6 = 0
ITOILET. PRIVATE INSTALLATION 3 0 3 = 9
MISCELLANEOUS DFU TYPE NUMBER OF EDU'S
20 = 0
TOTAL DRAINAGE FIXTURE UNITS 27 I
*EDU (Equivalent Dwellin~ Unit) is a dischallZe equivalent 10 a single family dweJ1in~ unil (20 DRJ's) sel at 167 2allons perdav J
MWMC CREDIT CALCULA T10N TABLE: BASED ON COUNTY ASSESSED VALUE
YEAR
ANNEXED
BER)RE 1979
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
CREDIT RA TE/$l ,000
ASSESSED VALUE
$4.92
$4.92
$4.83
$4.77
$4.64
$4.47
$4.30
$4.09
$3.78
$3.41
$2.98
$2.52
$2.06
$1.64
$1.45
$1.31
$1.13
$0.97
$0.82
$0.63
$0.41
$0.22
$0.04
IS LAND ELGlBLE FOR ANNEXATION CREDIT'?
(Enter I for Yes. 2 for No)
IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT'?
(Enter 1 for Yes. 2 for No)
BASE YEAR
o
2000
CREDIT FOR LAND (IF APPLICABLE)
VALUE/lOOO CREDIT RATE
$23.77 x $0.04
= ,
$0.95
CREDIT FOR IMPROVEMENT (IF AFfER ANNEXATION)
VALUE/lOOO CREDIT RATE
$0.00 x $0.04 =
o
TOTAL MWMC CREDIT
=
$0.95
--'
.-
...
-
P.?... Willamalane
t~~ Park & Recreation District J b N
o. o.
SYSTEM DEVELOPMENT CHARGE
WORKSHEET
"lJ\ ~~'~
~.
\
NAME.
. ADo"RESS: \>0
PHONE: \l&o .~S~s,
STATE:'Ere.. ZIP: ();t..\Cf:)
LOCATION OF PROPOSED BUILDING SITE: ..
Street Address:- -\.\OD.ln . .\\l11 ~oot.
. '-.)-
Plat Name: ~\{\ ~ Tax Lot Number:
1 ~ 'DEVELOPMENT TYP.!; (Checkapproprlate dwelfing(s). sac calculaUons and dwelfirig t
. }'I)e delin!!lons are on the back.)
A Sinofe-F::lmilv Oet::lcheQ
\. Single Family home
. NO. OF UNITS \
Manufactured home not in a park .
X $1,000 perunit=$J.IYYlt>O .
B. Rinole-F::lmilv Att::lchec;[
. NO. OF l!NITS .
X $924 per unit . ':. $
C. Multi-Familv Aoi1l1ment .
NO. OF UNITS
X .$692 per unit - $
D. M::lrltlf::lr:lureci Hom4'l Park
$
$
\ ~rY) .00
ft
$\000 .00
NO. OF UNITS
. WILLAMALANE SDC
X $699 per unit =
2. SDC CREDIT (II appUcable) saCiJayer must lurnIsh prool 01
Willamalane Credit approval. See SDC Credit Wolksheet. $
. ,
3; TOTAL WtLLAMALANE NET SDC ASSESSED .
(il sac reduced lor Credit)
\,~" \ J\UJ~
~~ selVicesXJ~~t
City of Springfield. .
')1
2-7 1
oJ
Date
. ;",_. ,')>,l22.sFlFTH'STREET :;.' _ ~"..'."'" f'~ ';'''f.~. lJ1;' ;\1 .r.. Ek....C~PER.l'v1IT APPLICATION, ". .
,'..,.\;ti;';,!.~.::SPiUN.drikD,ORE...ijON9i4.77'..:~I"'" '"' ><' '~.'J1>. "'.. ,.~,,,,'.' . "".',-'..~ '.~"
"'.~ ~ 1-~ ~ . ',.." ,~,- , . ',-' - .(J'_' ~~ ~' t~~ (.t::rb~ :'fJ~~;~ \~ :"a.r, 1; Cd ,'., . l~.; ::.,>:'''. .~ - /';'r~
.!i;;:~~<:,... @i...,,,-, INSPEc:r..IO.l':I:REQlJEST:..'726.,'~7p69:;' '. \"- iilo!C1tv Job Number'. ' , .. ,,< . ,. ';, .4Jii:.
'W7..1r. m','6fFlCE::~,'726:3759~;;;~f~; I. ; .. '. W- ili f}:::;;'i'~~"""'~.W"Il";;"':""'.irr~~5;
~ ~ m - .1r" $ , ,,~~~, .;:o-'{"'~~,r...~..."~~~\.i,~~<J;'~" '''l.''~'':i-''~f~''''''
~;" ~ ','z' ~?~;'t'~~>\~~i. s,', '.LCOMPLl.hE FEE SCHEDfJifBEL0\v4 ~:~~({~~~~&:'~
5ft~ 71~C~'^>IO~}tfAL~. ~"fON) ~~~'N' li.~\',,~'\5~~":; "'.-~":~r.~.\~fit;
~~~J ,." ' . \~,." -.,~ . "",' ~ ~~< 1fF'~ ~''1~~~~~'7 "Ff"'i:'i.~,,:r"'J.."!;S(.:t...,;<~"t!j >';~;
;:~.-::''':'- ~n"" -'~ '-1~"';': _ . A: Ne,\'~Rcsidcnthll-Single or..:t....... ..~\:',~~~:._1'...~'J: ~-4f..'..~~~
...:J Multi-Family per dwelling unit. :~:
LEGAL DESCRIPTION 0Irv-, Service Included: . ,~,~l
\ ~nL()s,'3 06t.N.-I..j Items Cost s~ili1l'
'}~1IRIPTI1:' - ~(p 1000 sq. ft. or less ~$106.00 JJioP'
~ ,\ ;;c~ ~~~~~:::~ 500 ~ ;~~ 00
Permits are non-tr~ns ble and expire thereof f -'...l $ I 9.00 '\i)I\"~l).
if work is not'started within.ISO days Each Manuf'd Home or ,~J~
. ~,
of issuance br if work is suspended for Modular Dwelling ~~,'
180 days. t::]'.. Service or Feeder .;j!}.'~'':?::,?:- $ 50.00
- - j'.:~.."....''''"~.'~.i ~. . ~. 10. -,,~.;..,
_ P-; _ ~~ ;-1'-<.;. ~:~[: -
2 CONTRACTOR ~STALLATION ONLY B. Services or Feeders ~ilr" ., ..'
E'lectriCa1"E~~Ltoft;.~Po.l"' 's ~le~R\'(' ~:I~~~::~~~' Alteraiion1~or ',,"'. "h..
Address .l~~ 6~g_~ f).;~~~
. . ~ ;l!\e~t.\D1..
City 1Jl\I,~![J-l:t~hone '1,...
~~.
~uP~~'iS~f,)icet~e~~' ;. ~er
.,
, "
~ ., . .
(~:\ ',~~~ .~>,' ','
.::-;,:< .
.J>~.(~~~~: 5~s
. .oJj~nips.to. ~O.oam
.~~ '_ij,~{.--x;.,.:-,.v.,
6~r~i!.0lii.\',~~..q,~Il1gs
. Over 600 amps o)!6.000vo
"BII above
.t"
O B b C."'f!'.
. ranc 4P:~n!S, '.' r-1. . , _
Ne"~~j~l1on or fxtenslOn p~. L<'~,
8i,wr}~~:' I ~~ '\1"~~ . ..
O:,e ~1~c!;1JL' . ~<' ~ ~~"\~~)"~. ,~j~:9~.....~... .".'"i!"
}i~ ~_;::'.~'~~~f:~.}..;..'!. <- a..~" G.~~il";~,rr.:t~~.::&."],";f'; .-;:.' ~'f.'io\iC('
" .""y"!~:, <,i>-.~..o. ~.','(\" :~.;rN..".~';i:''f1'.~''''~'~..'<.'
Ea<;h'.Addl~"()~~l\ ~\\'ilft Serylce,,;t,.c'i,' :1;:' ;;~~.;;:'
c.orFe~~~it\;i,*\S . ~5. $}.oo;i;" '.,,>
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~~ li5fe~~~~ ~~~~edcr not inc\u~d) .'" <. ,z,
"\'-?\"\~~~!\<;R,'i~S.1f1~h'~." ";,..
~\J ~~nl ~~igation-:_ .'. _$50.00~
,,<J'i~o uthne Lighting. . _ $50.00 _ '.
~~tl11ited EllergylRes.. $25.00
, Limited Energv/CoI1lui $-15.00..
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!\linimum Electric Permit Insjlcction Fce is S.+5.00 + Surcharges
4. SUBTOTAL OF ABO~E .2D\ pC) .
7% State Surcharge \~ 0. , ~ I
8% Administratiye Fee.' A 0
TOTAL 1~~.\\
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