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Home My WebLink AboutPermit Building 2005-3-1 ,. Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line --. .. ., CITY OF SPRI1'\j\,d'IJ'.LU Building/Combination Permit PERMIT NO: COM2005-00094 ISSUED: 03/0112005 APPLIED: 01124/2005 EXPIRES: 09/0112005 VALUE: $ 185,732,00 '* SITE ADDRESS: 195 Kaylee Ct 197 ASSESSOR'S PARCEL NO.: 1703271103500 Springfield TYPE OF WORK: Duplex PROJECT DESCRIPTION: WilIowbrooke subd lot 6 - Duplex TYPE OF USE: New Owner: GYANENDRA PRASAD Address: 4260 DAISY ST SPRINGFIELD OR 97478 Contractor License Expiration Date DUANE A KNIGHTS 12112 07110/2005 BATEMAN ELECTRIC INC 151911 06/21/2008 MARSHALLS INC ATTENTION' 0 2';;720 . 12/23/2005 SHAD CHASAN SURREIT f.-:I,nw ""00 ..:..._~e:(5il~99W reqUlreS017W4'J2006 .. . , .- --- 00;1 u.... Vn::::YUII Ullllty I BUlI.;DING.INF0RM:AmIOf'i1se rules are set forth . ~',V':'M ":~-UU1-00l0 through OAR 9 .1- # of,Storles.! may obtain copie!j.,J.f th Eo~~i2P, Height!OJj~I11I\S~fiter. (NI~[l't/j tel %liUfftiIDFloor: TYPCJIl(iJt~a".;r the Orego cf.~?N ~d Floor: Water TYPe'-enter is 1-80 . ~Ji'm' 0 ~~lB8sement: Range Type: ~44)"'q Ft Garage/Carport Energy Path: Path I Sq Ft Other: Sprinkled Building: n/a Occupant Load: Contractor Type General Electrical Mechanical Plumbing . # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: . Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Subdivision Not Accepted Street Improvements: Storm Sewer Available: Special Instruction: 2 R-3 U VN 18.00 6.00 10.00 10.09 36.00 I CONTRACTOR INFORMATION I 2 I DEVELOPMENTINFORMATlON I Residential Phone 541-726-2960 541-995-4757 541-747-7445 541-741-3553 5,242 896 274 REQUIRED PARKING Total: 4 Handicapped: Overlay Dist: # Sti:\>iiffilrees Rqd: 4 ..w"'.1uL, PavedDrivef~d:. Yes Compact: I' '10 ...rni," I SHALL EXPIRI: 1- % oftfot Clivera,ge: 45(ooTHE WORK P. I AUKILEu UNOER THIS PERMIT IS NOT r.nMMnli'l:n nn >C' ^"...__. __ I PUBLIC>lMPROYE~L"TS.~D:-' "'uU"Lu run Sidewalk Type: Partially Improved I Yes DownspoutslDrains: Notes: No hook-up to City Infrastructure until Public Improvements accepted by the City 1/27/2005 CAS Page I of4 Curbside 5' To Storm Sewer . . CITY OF ~rK1I~ut<lJ<..LlJ Building/Combination Permit PERMIT NO: COM2005-00094 ISSUED: 03/01/2005 APPLIED: 01/24/2005 EXPIRES: 09/01/2005 VALUE: $ 185,732,00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Valuation Descrintion I Dwellines Garaee Tvpe of Construction V Wood Frame Garaee $ Per Sq Ft or multiplier $96.00 $25.00 Square Footage or Bid Amount 1,792.00 548.00 Value Date Calculated Description Total Value of Project $172,032.00 $13,700.00 $185,732.00 01/24/2005 01/24/2005 Fpp<. PiWIJ Fee Description Amount Paid . Date Paid Receipt Number Plan Review Residential $549.35 1/24/05 1200500000000000103 -Mechanical Issuance Fee-- $10.00 3/1/05 1200500000000000275 + 10% Administrative Fee $148.01 3/1/05 1200500000000000275 + 70/0 State Surcharge $103.61 3/1/05 1200500000000000275 1 Bath One & Two Family $290.00 3/1/05 1200500000000000275 Addressing Assignment $62.00 3/1/05 1200500000000000275 Building Permit $845.15 3/1/05 1200500000000000275 Curbcut Permit $75.00 3/1/05 1200500000000000275 Dryer Vent $12.00 3/1/05 1200500000000000275 Exhaust Hoods $18.00 3/1/05 1200500000000000275 Minimum/Adjustment Mechanical $15.00 3/1/05 1200500000000000275 Plan Review Major - Planning $103.00 3/1/05 1200500000000000275 PW Disc - 2nd Permit (Street) $-30.00 3/1/05 1200500000000000275 Residence Wiring 1000 Sq Ft $212.00 3/1/05 1200500000000000275 Residence Wiring Ea AddU 500 $38.00 3/1/05 1200500000000000275 Sanitary Sewer - Improvement $475.28 3/1/05 1200500000000000275 Sanitary Sewer - Reimbursement $625.04 3/1/05 1200500000000000275 SDC MWMC Administration $10.00 3/1/05 1200500000000000275 SDC MWMC Improvement $1,730.62 3/1/05 1200500000000000275 SDC MWMC Reimbursement $164.06 3/1/05 1200500000000000275 SDC Sanitary/Storm Admin $155.88 3/1/05 1200500000000000275 SDC Transpo Admin $139.79 3/1/05 1200500000000000275 SDC Transpo Improvement $1,544.98 3/1/05 1200500000000000275 SDC Transpo Reimbursement $350.26 3/1/05 1200500000000000275 Sidewalk Permit $75.00 3/1/05 1200500000000000275 Storm Drainage Impervious Area $1,013.08 3/1/05 1200500000000000275 Temp Power 200 amps or less $50.00 3/1/05 1200500000000000275 WlIlamalane Attached (duplex) $1,848.00 3/1/05 1200500000000000275 Total Amount Paid $10,633.11 I Plan Reviews I Initial Review Plannin!! Review 01/26/2005 01/26/2005 01/26/2005 02115/2005 APP SKG APP EMM See attached letter for survey. Paee 2 of 4 . . CITY 01< ~rKll'lul'l~L1J Building/Combination Permit PERMIT NO: COM2005-00094 ISSUED: 03/01/2005 APPLIED: 01/24/2005 EXPIRES: 09/01/2005 VALUE: $ 185,732.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Public Works Review 01/26/2005 01/27/2005 . APP CAS Structural Review 01/26/2005 02123/2005 APP DLM No hook-up to City Infrastructure until Publilc Improvements accepted by the City: storm drainage piped to system. 1/27/2005 CAS Reviewed by Jason Bush. 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, UeollirerU""r\oectio"" I Sidewalk - Curbside: After forms are erected but prior to placement of concrete. Curbcut - Standard: After forms are erected but prior to placement of concrete. Site Inspection: To be made after excavation but prior to setting forms. Vfer Electrical Ground: Install ground rod at footing and call for inspection In conjunction with footing and/or foundation inspection. Footing: After trenches are excavated. Foundation: After forms are erected but prior to concrete placement. Post and Beam: Prior to Ooor insulation or decking. Floor Insulation: Prior to decking. Framing Inspection: Prior to cover and after all rough in inspections have been approved. Wall Insulation: Prior to cover. Ceiling Insulation: Prior to cover. Drywall: Prior to taping. Hold Downs Installed: Special Inspection performed prior to placement of concrete. Provide report to City Building Inspector. Shear Wall Nailing: Before covering sheathing with finish materials. Final Building: After all required inspections have been requested and approved and the building is complete. VnderOoor Plumhing: Prior to insulation or decking. VnderOoor 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. Storm Sewer Line: Prior to filling trench. Final Plumbing: When all plumbing work is complete. VnderOoor Mechanical. Prior to insulation or decking and including required testing. Rough Mechanical: Prior to Cover Final Mechanical: When all mechanical work 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. Pal1e30f4 . . L11 f OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2005-00094 ISSUED: 03/0112005 APPLIED: 01124/2005 EXPIRES: 09/0112005 VALUE: $ 185,732.00 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769Inspeclion Line By signature, 1 state and agree, tha't 1 have carefuUy 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 he 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 Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 wiU 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 wiU remain on the site at aU times during construction. Owner or Contractors Signature Date ~a4-~ Pa!!e 4 of 4 .~ 225 Fifth Striet . Springfield, Oregon 97477 '. '. 541;:726-3'759 Phone . iralW> iE'.'.'~-"".'.".' . ."'-." '........ > ....,--. : . , .. '..~, 1 1111'" " .; .... ..'"'. "'"'0"',' "C' . ""'~,t:' ' , ,.;.' .ar of Springfield Official Receipt .elopment Services Department Public Works Department Job/Journal Number COM200S,00094 COM200S-00094 COM200S-00094 COM200S-00094 COM200S-00094 . COM200S-00094 COM200S-00094 COM200S-00094 COM200s-00094 COM200S-00094 ., COM200S-00094 \,COM200S-00094 COM200s-00094 COM200S-00094 COM200S-00094 COM200S-00094 COM200S-00094 COM200S-00094 COM200s-00094 COM200S-00094 COM2005-00094 COM200S-00094 . COM200s-00094 COM200S-00094 COM200s-00094 COM200S-00094 COM200S-00094 , 'Payments: Type of Payment Check , " . 3/1/200s RECEIPT #: 1200500000000000275 Date: 03/0112005 Description Addressing Assignment Willamalane Attached (duplex) Residence Wiring 1000 Sq Ft Residence Wiring Ea Addti SOO Temp Power 200 amps or less Sidewalk Permit Curbcut Permit PW Disc - 2nd Permit (Street) 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 Plan Review Major - Planning Building Permit I Bath One & Two Family Exhaust Hoods Dryer Vent Minimum/Adjustment Mechanical -Mechanical Issuance Fee- + 7% State Surcharge + 10% Administrative Fee Paid By DUANE KNIGHTS Item Total: Check Number Authorization Received By Batch Number Number How Received djb S393 In Person Payment Total: Page I of I 2:46:29PM Amount Due. 62.00 1,848.00 212.00 38.00 SO.OO 7S.00 7S.00 (30,00) 1,013.08 62S.04 47S.28 3S0.26 I,S44.98 164.06 1,730.62 10.00 ISS.88 139.79 103.00 84S.1S 290.00 18.00 12.00 IS.00 10.00 103.61 148.01 $IU,U83.76 Amount Paid $10,083.76 $1O,U83.76 ,. , ' . CITY OF SPIGFIELD SYSTEMS DEVELOPMENaRKSHEET JOURNAL OR JOB NUMBER: NAME OR COMPANY: LOCATION: TAX LOT NUMBER: DEVELOPMENT TYPE: NEW DWELLING UNITS ri o U et: ~ E-< '" t3 ~ COM2005-00094 Prasad 195 197 Kay!ee Ct 1703271103500 SINGLE FAMILY RESIDENCE 2 BUILDING SIZE (SF: 2340 LOT SIZE (SF): 5242 1. STORM DRAINAGE DIRECT RUNOFF TO CITY STORM SYSTEM I IMPERVIOUS S.F. x 1 COST PER S.F. CHARGE I I 3268.00 I $0.310 I = 1 $1,013.08 RUNOFF ROUTED TO DRYWELL DESIGNED AND CONSTRUCTED TO CITY STANDARDS 1 IMPERVIOUS S.F. I x r COST PER S.F. I x I DISCOUNT RATE I I 1 0.00 1 $0.310 1 I 50% = I ITEM 1 TOTAL - STORM DRAINAGE SDC $1,0\3.08 2. SANITARY SEWER - CITY A. REIMBURSEMENT COST: 1 NUMBER OF DFU's I x 1 26 B. IMPROVEMENT COST: .1 NUMBER OF DFU's I x I 26 $18.28 ITEM 2 TOTAL - CITY SANITARY SEWER SDC DISCOUNT $0.00 $1.013.08 1070 COST PER DFU $24.04 $625.04 1091 $475.28 I 11092 I = , $1.100.32 ] TRANSPORTATION A. REIMBURSEMENT COST: I ADTTRIP RATE I x I NUMBER OF UNITS I x I COST PER TRJP x INEWTRIPFACTORI I 9.57 1 2 1 $18.30 1 1.00 $350.26 1093 B. IMPROVEMENT COST: I ADT TRJP RATE I x I NUMBER OF UNITS 1 x I COST PER TRIP x INEWTRIPFACTORI 9.57 ! 2 1 $80.72 1 1.00 $1,544.98 1094 ITEM 3 TOTAL - TRANSPORT A nON SDC = , $1,895.24 4. SANITARY SEWER - MWMC A. REIMBURSEMENT COST: INUM8ER OF FEU's 1 x ICOST PER FEU 1 2 1 $82.03 = $164.06 I 1054 B. IMPROVEMENT COST: I 1 NUMBER OF FEU's 1 x ICOST PER FEU 1 2 1 $865.31 = $1,730.62 1055 MWMC CREDIT IF APPLICABLE (SEE REVERSE) $0.00 1054 MWMC ADMINISTRATIVE FEE $10.00 1056 ITEM 4 TOTAL - MWMC SANITARY SEWER SDC = I $ 1,904.68 SUBTOTAL (ADD ITEMS 1,2,3, & 4) = I $5,913.32 J 5. ADMINISTRATIVE FEE: I 1 SUBTOTAL x 1 ADM. FEE RATE 1= CHARGE I $5,913.32 I 5% I $295.67 TOTAL SANITARY ADMINISTRATION FEE: 155.88 1079 I ]OTAL TRANSPORTATION ADMINISTRATION FEE: $139.79 1078 Cheryl Slaymaker 1/26/2005 TOTAL SDC CHARGES =, $6,208.99 PREPARED BY DATE . . . . DRAINAGE FIXTURE UNIT (DFU) CALCULATION TABLE NUMBER OF NEW FIXTIJRES x UNIT EQUIVALENT - DRAINAGE FIXTURE UNITS (NOTE: FOR REMODELS. CALCULATE ONLY TIlE NET ADDmONAL FIXTIJRES) NO. OF FIXTURES DRAINAGE UNIT FIXTURE FIXTURE TYPE NEW OLD EQUIVALENT UNITS I BATHTUB - 2 0 3 6 = IDRlNKING FOUNTAIN 0 0 1 = 0 I FLOOR DRAIN 0 0 3 = 0 I INTERCEPTORS FOR GREASE lOlL 1 SOLIDS 1 ETC. 0 0 3 = 0 I INTERCEPTORS FOR SAND 1 AUTO WASH 1 ETC. 0 0 6 = 0 I LAUNDRY TUB 0 0 2 = 0 ICLOTIlESW ASHER 1 MOP SINK 2 0 3 = 6 ICLOTIlESWASHER - 3 OR MORE tEA) 0 0 6 = 0 I MOBILE HOME PARK TRAP (I PER TRAILER) 0 0 12 = 0 RECEPTOR FOR REFRlG 1 WATER STATION 1 ETC. 0 0 1 = 0 RECEPTOR FOR COM. SINK 1 DISHWASHER 1 ETC. 0 0 3 = 0 SHOWER. SINGLE STALL 0 0 2 = 0 ISHOWER. GANG (NUMBER OF HEADS) 0 0 2 = 0 ISINK: COMMERCiALiRESIDENTIAL KITCHEN 2 0 3 = 6 ISINK: COMMERCIAL BAR 0 0 2 = 0 ISINK: WASH BASINIDOUBLE LAVATORY 0 0 2 = 0 ISINK: SINGLE LAVATORYIRESIDENTIAL BAR 2 0 1 = 2 IURINAL. STALL 1 WALL 0 0 5 = 0 ITOILET. PUBLIC INSTALLATION 0 0 6 = 0 TOILET. PRIVATE INST ALLA TION 2 0 3 = 6 MISCELLANEOUS DFU TYPE NUMBER OF EDU'S 20 = 0 TOTAL DRAINAGE FIXTURE UNITS 26 I .EDU (Equivalent Dwelling Unit) is a discharge equivalent to a single family dwelling unit (20 DFU's) set at 167 gallons per day .-~ -- -- MWMC CREDIT CALCULA nON TABLE: BASED ON COUNTY ASSESSED VALUE BEFORE 1979 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 19% 1997 1998 1999 2000 2001 CREDIT RATElSI.OOoI ASSESSED V AWE I $5.29 $5.29 $5.19 $5.12 $4.98 $4.80 $4.63 $4.40 $4.07 $3.67 $3.22 $2.73 $2.25 $1.80 $1.59 $1.45 $1.25 $1.09 $0.92 $0.72 $0.48 $0.28 $o.Og $0.05 YEAR ANNEXED IS LAND ELGl8LE FOR ANNEXATION CREDIT? (Enter I for Yes, 2 fnrNn) IS IMPROVEMENT ELGlBLE FOR ANNEX. CREDIT? (Enter I for Yes, 2 for No) BASE YEAR 2 I I :' 2 1979 CREDIT FOR LAND (IF APPLICABLE) VALUE 11000 CREDIT RATE $0.00 x $5.29 ~ , $0.00 CREDIT FOR IMPROVEMENT (IF AFTER ANNEXATION) VALUE 11000 CREDIT RATE $0.00 x $5.29 o TOTAL MWMC CREDIT = $0.00 ... I'.' SPRIN~ 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(54I)726-3753 . FAX: (~~~"t~t. ~-.~ ELECTRICALPERMITAPPUCATION . 0.. '''o&s%Ct... '.- . r_.' ~ ~ ~. . City Job Number ( ~, -Oooq..,.. Date AI,.. . ~ 0"0 1,& s'-'6 . -0 ~ %z'~ .,.,. "' .,.~ <r{::J I. 'JffkjeATidN'iJjj,iNST:A'iZi;4.if.i(.jN..,.".'7fh[~t.j 3. ll!'eeMPi:EiEiFEE! .....':~ .;.t'aM'.o~,{<?l!.Mt~~~_IfJ1, ~1.q~'~7/Q"';"~7;;:,,~:~...~r<~ L'~'.'-'h_'_~H~." <& -, ..~; ~..,,:i;;;~~' yt A f:'I'l"'"R"'.'iF'ffii~s~""~~1S.,"!S':'i'~ ; .,,' ~lli,.....;.p-8'1>'\;jJ LEGAL DESCRIPTION . fl.. .!'.1Y> ."~,..!'!!,.,~,,;;;,..!~g ~.~~!!1!!.'!!9;..J!.... '. . w.!'_.!Ig;J!!lL~;;i' f'1o'1 '27J../1 n 'Z SOo Service Included ~ JOB DESCRIPTION 1000 sq. ft. or less 2 106. 21l,<:o Each additional 500 sq. ft. or 0 . f2e..;1&b1J..I,,) D.Jn~)( portion thereof L- $ 19.00 ~6,oo Permits are non-transferable and expire if work Is not started within 180 days of Issnance or If work Is Snspended for 180 days. Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 liI'c'..o>~';':;;;"", 'M~.'A' "CTO~"""""R.*",""r~Ji'1:;T'4:::;"" . 0.'.':-;;'''''...'0.7''''. ......TX}... ....._""<=.>~J<~N_.~.._~~>"...~....~.""~~,,~~~....~~~' j~ ~ '2". . .L'W:.r.~ . ~.LL'Wo::J:.r.~AI...r 'La' ~V:!.' nL':.r...- B. services1or'F,..eea.-efj._-f;~~IDSta.'i1,.a~~tro~,T'_'~.',..t~ra.._tiO.;;._.l..O....!..Jit..~.~!t!~. .ti:....-.o.~,ift.r~.J 2. ~_.,.-~..~~,:.""_."'.-~ff.-a;:;.Ai.irM~.~~'noS.~~o;:-;<.'\,~.~.t....,.,"'~".,.~ ~-. . .-..-. . .~". ,--;::=.-..,~::!'" ElectricalContrnctor ~{\t{m(lV\ 8ectnc, 200 Amps or less $63.00 ~ I L \Ie. 201 Amps to 400 Amps $ 75.00 Address qLfl ~ ilL\.. y- f\ DO\,-:' ~~~~ 401 Amps to 600 Amps $125.00 . . (,tv ~'\i 1 ~N I Ol'/io )A~!\'lltlOlAllil\5ilS you to $163.00 Cityl I'u....fcn D'\ l.\,Yhone on (<,-~lrI. ,~~:~ m ?Pt860~gon Utility $375.00 in OAR 952 0 WJ. 'Mm;!(!v0idyrules are set forth $ 50.00 . 01.0010 throuph OAR A~:l.M1_ -I'\('DI- &..090. You nc!Y&MIa"""""'S6'iiiiit.~~j'>'~f'!:~:"'\tt.~:,., '.'l~r~~ Supervisor License Number ,)/) V.) _.J,:,~IUng the cEll/ter. P~~~:'ihe t::;~~'''''''''''''''''''''';"'1M';;",,~j;4;f';'' it! Expiration Date i LJ - \ - () 'I number for t~/MililltDll1I, 16tIlilylMYtRrcifiIaft'tlon . . CentllJ~A~a,.2344). } $ 50.00 ~O.QQ Constr. Contr. Number _ Ii. \ "=> \ q \ I 201 Amps to 400 Amps $ 69.00 I '1_ -'71-0',q 401 Amps to 600 Amps $100.00 Expiration Date U. . t- Over 600 Amps or 1000 Volts see "B" above. S,'gnature ofSunPrViSl'ng Electn'C1'an D. ~Brfn~iiIG~CUi~!~~~t~~~~~~J.:'~;J~;~?;;fs;,:;-~~~~w;;d 1"""4" - -,','. _. _.-<-".' ""_' ~ .~J;'l'~':~~~'1'r';~.fk-~"t";"ij.'"~':s~,,l~h,.,o.. <<- ,'l'':, ~.._,.~ /7'/ .....?-- New Alteration or Extension Per Panel /.L~/A'~' ~... _ One Circuit $43.00 / / Each Additional Circuit or with OAwnddrersSSNa:; ~:~ ~~~ c- 'd~S~~lpcl;~i~;;;;~eif~ir.~ti~~liia~)'::~jj\'I~iiilli1fu~:~ e '>1 Ll"'.....co....' "" ,~ O';"ViliU~ ;~*flfrtE"ffflr~URIt"'m"'~""'^,'~--"""''''''J City b...J ..,.-t77vC' Phone 6'6/' 9 ~~ME$4J1ol,\PJlJifati1ih'IS PERMIT IS ~I')T $ 50.00 ANY 180 ~i~&\liJ~Ilighiihg)ONED FOR - . $ 50.00 OWNER INSTALLATION ~~trJfrJ.Q8YJResidential $ 25.00 The installation is being made on property I own which Limited Energy/Commercial $ 45.00 is not intended for sale. lease or rent. Minimum Electric Permit Inspection Fee Is 545.00 + Surcharges Owners Signature: t!;.,'.' "''-l/~:l.'t.:.'io':~;;';';.:.~'it-,~':~~r~-'''\f(''?I.~'f:S'''''~I~'~'' t'?ni ,'; .i1Pn~ 4. "SUBTOTAL'OP.A'BOVE':;"'<"~' . .m.A:::,: '.,:" :r~...,~"-~~,..,,.....,..-,,~ -.1'-..-1"........-,..'....' ..,""-d,~~."':i',.ii~.~~J"'".~\ttf:::O>';~ ~..~,.-~ ~,.""""""1(;oi.~,."..."~".~..,;.........,,"~"'?lf,,.~~~.'F{" ,-~Ji,' ~,,',-,"~ 7% State Surcharge 10% Administrntive Fee ~ 00 ,00 2/,00 10,00 .(I ~ .0. OlD Inspection Request: 726-3769 TOTAL