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Home My WebLink AboutPermit 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;" '.,,> ~~"H,,,~:,,,,\~\Sc.~Y ':., :'. ',. .~. ~~ 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.. .. ~ ,,,. ..::r...,.:....: :" -. . -<;.~;~; ,. . e ':,l'Owncrs Slunature: . . /~ .' .' .'. ~ 1 .);'__, .' j-- "",,', -,' :~ ~~: =-, ~", .. ....-. ..' ;;~:~.:,..!~~~::',.t.f.'.(_i::;';:.'. , '.':" .-'::,'. .. !\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~~.\\ ";'. :!;~,Y:~~~r: "". -.<' ',<. ., ~ ',:-' .-<..