HomeMy WebLinkAboutPermit Electrical 2008-4-25
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INITIALS ~ __
DATE ~ ..v~
SOURCE l1^-f Wr
Date -<j -- c;J S- .-- OP
225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
ELECTRICAL J?~RMIT APPLICATION
City Job Number L 7- O() 9 d '-,L
1. LOCATION OF INSTALLATION:
~?~97 :AL'Mh{t;.1k ~r'~
LEGAL DESCRIPTION
/ / () ;;)-. / 1 4'-5 () If ~ l)L)
JOB DESCRIPTION:
/ertt::OIf 1JJ vac~ st/5tem.
V
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",
~~i > '/ " Hi>>>>>
Electncal Contractor
Address
"-
',,-
CIty "" Phone
supcrvi=LiC~ //
Expiration Date /
Constr. Contr. Number / "''''''
ExpIration Date /
sigua7"",mg Electncum
"
"-
'-,
Owne", Name lr~ --rl.f5~
Address :J.5~ 0 Al, 7_7 t~
CIty .5i{'~ i1Kl~\ ell Phone 74 {- ~ N.5
I {J
OWNER INSTALLATION
The mstallatIOn IS being made on property I own which
is not intended for sale, lease or rent
Owners SIgnature:
----
: Gt 1\4
~- ;t
~/
I'
Inspection Request: 726-3769
SPRINGFIELD
,
&l,.
tt
!~
3. COMPLETE FEE SCHEDULE BELOW
/ "".w~",~""
A. New Residential- Single or M~lti-"!~mjJy per dwelling unit.
Service Included
1000 sq. ft or less
Each addItIOnal 500 sq ft or
portIOn thereof
Each Manufact'd Home or
Modular Dwellmg ServIce or
Feeder
$11700
$ 21.00
$55.00
, <<<<, {r~"q'
B. Services -or Feeders - Jnstallation~ Alte~ations or Relocation:
/ /' , '" (/r\i,//"t ",t" ~;::*)i, h N ~~ ~
200 Amps or less $ 70.00
201 Amps to 400 Amps $ 83.00
4'HfiilR}fN 600 Amps_ ..- .J!dffl<OO
6q-l~P'{1l3~MID~L EXPIRt ~~ ~m: ~~O
o~~Il'm<?wMfPSrW'WER THIS Pcn\Viff-tSJ413 00
R~~~~~~D OR IS ABANDul~cO ro~ 55 00
,1.\N"{,130 DAY ~E~,lpp. ;
c. 'Temporary Services or Feeders "" "" I,,'
Installation~ Alteration or Relocation
200 Amps or less . ~oU'tw
201 AIIltllT<E4lJ'O~pQreqon law I \:::YUII es rf (1~loo
.. J ..I, " arloptE:d by the Orego ,ny
401 AIftps~(t SOu Wirl,t;!'S '" Those rule~ are HUfbOOl
J~s~t~I2.~~on CenLr. h "ll.!=l 952-001-
Over 9W~fIJ:9!9E -tQWOO1JfS ~~lml al16Ve
D. BraOCQ1{f;i~ay obtain copies of the rules by
, ',I th" center'" JNete: the telephone
calltng l e . \ N t f'catlon
New AIW6Mt99rq5~e~~IB'ii"\\t 0 II
One CirCUlt Center IS 1-800-332-2344)'$ 48,00
Each AddItional Circuit or with
Service or Feeder Permit $ 4.00
~~'~' v " "",' \
E. MiScellane~us ''(Service/feeder notjncluded) -Each Installation
Pump or lITIgation $ 55 00
SIgn/Outline LIghtmg $ 55.00
Limited EnergyIResIdentia1 / $ 28.00
LimIted Energy/Co~----- -~~OO
Mini~~m Electric, ~~,~~,~~ ~ Fee i~ $50~~JUrcharges
4. SUBTOTAL OF ..;tROVE, ,," I ,--~" 6D, OV
12% State Surcharge ~ - S cJ
10% AdminIstratIve Fee (Q, 'Cl:?
5% Technology Fee <-","'S ()t)
:? SO
TOTAL 0~ _
Shared Drlve(f )/BUlldmg Forms/Electncal Permit ApphcatIon 1-08 doc
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
Job/Journal Number
COM2007-00924
COM2007-00924
COM2007-00924
COM2007-00924
COM2007-00924
Payments:
Type of Payment
CredltCard
cRecemtl
RECEIPT #:
2200800000000000525
Date: 04/25/2008
DescnptlOn
Low Voltage - ResidentIal
M InImum/ Adjustment Electncal
+ 5% Technology Fee
+ 12% State Surcharge
+ 10% Administrative Fee
Paid By
TROY THORSBY
Item Total:
Check Number AuthorizatIOn
Received By Batch Number Number How ReceIved
nJm 011932 lnPerson
Payment Total:
Page I of I
2:20:53PM
Amount Due
2500
2500
250
600
500
$63.50
Amount Paid
$63 50
$63.50
4/25/2008
Construction Contractors Board Perrmt # ~ -; "i {J(j? dY'
700 Summer StNE Suite 300 Ad~s3:?,fl,:, dt~, ~,
PO Box 14140 /' ( "-
Salem OR 97309-5052 (Is~ 11-- ;)5-06
Phone: 503-378-4621 ~ued B I . Date
Web Address: www.ccb.state.or.us
Statement: Info. Illation Notice t~~perty Owners
About Construction Respo~sibilities
I,
1
Note. Oregon Law, ORS 701.055(4) requires residentzal constru.ctzon permit applicants who are not
llcensed with the Construction Contractors Board to sign the followmg statement before a building
permit can be issued. This statement is required for resldentzal/milding, electrical, mechanical and
plumbing permits. Licensed architect and engineer applicants, exempt from llcensmg under
ORS 701.010(7), need not submit this statement. This statement tvill be filed with the permit.
Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B:
~1.
D 2.
I own, reside in, or will reside in the completed structure.
I understand that I must become licensed as a construction contractor if the structure is sold or
offered for sale before or on completion.
D 3A. My general contractor is
(Name)
(CCB #)
I will instruct my general contractor that all subcontractors who work on the structure must be
"
licensed with the Construction Contractors Board.
OR
~ 3B. I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors
Board. If! change my mind and hire a general contractor, I will contract With a contractor who is
licensed with the CCB and will immediately notify the office issumg this building permit of the
name of the contractor.
,
I hereby certify that the above information is correct and that I have rea4 and do understand the Information
Notice to Property Owners about Construction Responsibilities on the re~erse side of this form.
~. ~J}Jy
(Sign~~ur~'~ermit applickbt)
,
(White copy to Issuing agency permit file, pmk copy to applicant.)
t( /z) log-
( ,
(Date)
Property_owner. doc 06-01-04
as
~
,
- . ,
. INFORMATION
\A~OUT
TO OWNERS
RESPONSIBILITIES
NOTE" This Information Notice to Property Owners about Construction Responsibilities was developed by the
Contractors Board In accordance with passed by the 1989 Oregon Legislature.
you are as your own contractor to construct a new
you can many problems by bemg aware of
or make a substantIal improvement to an existmg
respormbIhties and concerns.
.'
m most ruled to an
not lIcensed with the CqnstructlOJ1
of a 'resIdentIai structure.
" ,
contractors you contract WIn "employees" If
~9ard to do lab})r m con1>tructmg or to ~SSISt m the
you ~nst c9mply the following:
Ta~ Law: As an
You wlil be hable for
more call the
. . -
income taxes from wages at the time
even you don't actually wIthhold the tax from your
at 503-378-498'8,
more
you are required-to pay a tax for miemployment insurance purposes:
Employment at 503-947-1488,
on
Insurance
an
"
IdentificatlOn
Tax. To file for a
number for bo!h With~oldmg and
or \'Y,,{\v.dor.state oLus/fonnsnav.html1 for the
, .
Worke:rs' Insur:mce: As an you are subject to the Oregon Compensation Law,
and must obtam compensatiOn. msurance YO!lf, you fall to workers' compensatiOn
msurance, you could be subject to penalties habIe for costs if ~:me of your employees IS mJured on the
Job. For more call the Workers' DivislOn at Department Of Consumer and Business
ServIces at
Revennc Service: As an you must wIthhold"federal mcome tax
tax even If you dIdn't the tax. For a
Of VIsit theIr web SIte at w\"y._w 1J's,.g~)~.
" I
employees' wages.>'
, "-
EIN can the
Code
holder for
to your attent~o~
you are
for
any
to meet code
and
to see you have msurancc
water damage from pIpe punctures, or
~
and- omlSSlOns such as
. ,
,.
\1 '
\
J'" "\
t.\ .
"
Time:
sure you
to supervIse
as your own
as
to the
can perform the
of rough-ill
hmes so
or
at
"
doc 06-01-04
CITY OF SPRINGFIELD C
Building/Combination Permit
PERMIT NO: COM2007-00924
ISSUED: 09/25/2007
APPLIED: 06/21/2007
EXPIRES: 10/25/2008
VALUE: $ 276,077.00
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3497 Ambleside Dr
ASSESSOR'S PARCEL NO.: 1702194308200
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Ambleside 1st Add lot 150
Overlay Dist:
# Street Trees Rqd: 2
Paved Drive Rqd: Yes
% of Lot Coverage: 28.10
ATTENTION: Oregon Jaw requfres you to
;1'l'!!!!.U ,,,,,,l"'i) a-J,.J!"': v,J L y U 1<;; e:'Vl;:IVII U~;':;f,
I PUBLIC IMPROVEr~rNTS' I', I r~L :1;.;r 1 hose rules are set forth
1(1 '..' '" I;, :-G0Sfd1,Qj~I~~~~h OAR 952-001-
Fullv Improved ell -, /VG (nay ontam cd'~es of the rules by Curbside 5'
Storm Sew~;'C\'YMl4hte: Yes ,~, !:,,1~; the ceOmI$P:'()Qjstf>tbil1~elephonll'o Storm Sewer
Special Ins~1f~~_~i?Il:RMIT SHALL EXPIRE IF THE WORK I,urnoer for the Oregon Utility Notification
AUTHORIZED "\!n~%1I-H~ Center IS 1-800-332-2344).
Notes: StC)r..ml~a.t~rC-lJJuI"S t'rtit3 s'e'#ef~~hTrtstOOI stubs provided on the lot.
GUIVlIVlb~ tU GR IS BANDONED FOR
ANY 180 DAY PERIOD.
Owner: THORSBY TROY J & CARRIE J
Address: 2560 N 27TH ST
SPRINGFIELD OR 97477
I CONTRACTOR INFORMATION'
Contractor Type
General
Electrical
Low Voltage Electrical
Mechanical
Plumbing
Contractor
REGAL HOMES BY SHELLEY
BA TEMAN ELECTRIC INC
OWNER
HOME COMFORT HEATING & AIR
CRAIG ARNEY
License
168831
151911
84164
167015
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: 3
Height of Structure 40.50
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path: Path 1
Sprinkled Building' n/a
1
R-3
U
VB
3
I DEVELOPMENT INFORMATION I
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
10.00
15.00
5.25
40.00
0.00
Street Improvements:
Page 1 of 5
Residential
Phone Number: 541-510-3864
Expiration Date
02/28/2010
06/21/2008
Phone
541 998-3897
541-998-7187
06/25/2011
01/30/2008
541-345-2838
541.736-9582
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
1,332
947
780
780
REQUIRED PARKING
Total: 2
H!cwdicapped:
Compact:
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00924
ISSUED: 09/25/2007
APPLIED: 06/21/2007
EXPIRES: 10/25/2008
VALUE: $ 276,077.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3497 Ambleside Dr
ASSESSOR'S PARCEL NO.: 1702194308200
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: New
PROJECT DESCRIPTION: Single family residence - Ambleside 1st Add lot 150
Residential
Owner:
Address:
THORSBY TROY J & CARRIE J
2560 N 27TH ST
SPRINGFIELD OR 97477
Phone Number: 541-510-3864
I CONTRACTOR INFORMATION'
Contractor Type Contractor License Expiration Date Phone
General REGAL HOMES BY SHELLEY 168831 02/28/2010 541 998-3897
Electrical BA TEMAN ELECTRIC INC 151911 06/21/2008 541-998- 7187
Low Voltage Electrical OWNER
Mechanical HOME COMFORT HEATING & AIR 84164 06/2512011 541-345-2838
Plumbing CRAIG ARNEY 167015 01/30/2008 541.736-9582
BUILDING INFORMATION I
3
# of Stories: 3
Height of Structure 40.50
Type of Heat: Forced Air Gas
Water Type: Gas
Range Type: Electric
Energy Path: Path 1
Sprinkled Building. nla
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
1,332
947
780
780
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
1
R-3
U
VB
I DEVELOPMENT INFORMATION'
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
10.00
15.00
5.25
40.00
0.00
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
2
Yes
28.10
REQUIRED PARKING
Total: 2
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Fullv Improved
Yes
Sidewalk Type:
DownspoutslDrains:
Curbside 5'
To Storm Sewer
Notes: Stormwater and sanitary sewer to be directed to stubs provided on the lot.
Pa2e 1 of5
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Description
Type of Construction
Dwelline:s
Dwelline:s
Garae:e
v Wood Frame
Bmt Semi-Finished
Garae:e
Fee Description
Plan Review Residential
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 5% Technology Fee
+ 8% State Surcharge
3 Baths One & Two Family
Addressing Assignment
Appliance Vent
Building Permit
Curbcut Permit
Dryer Vent
Exhaust Hoods
Fire SF Fee - Residential
Fireplace (Listed)
Furnace - up to 100,000 btu
Gas Outlets 1-4
Miscellaneous Copy Chgs
Plan Review Major - Planning
Plan ReviewIResidential Hourly
PW Disc - 2nd Permit
Sanitary Sewer - Improvement
Sanitary Sewer - Improvement
Sanitary Sewer - Reimbursement
SDC MWMC Administration
SDC MWMC Improvement
SDC MWMC Reimbursement
SDC Sanitary/Storm Admin
SDC Transpo Admin
SDC Transpo Improvement
SDC Transpo Reimbursement
Sidewalk Permit
Storm Drainage Impervious Area
Storm Sewer Each Addtll00'
Temp Power 200 amps or less
I Valuation Description I
$ Per Sq Ft
or multiplier
$103.00
$26.00
$27.00
Square Footage
or Bid Amount
2,279.00
780.00
780.00
Total Value of Project
~
Amount Paid
$741.59
$10.00
$177.89
$95.75
$126.95
$306.00
$31.00
$6.00
$1,140.90
$80.00
$6.00
$9.00
$191.95
$15.00
$12.00
$4.00
$17.50
$198.00
$112.50
$-30.00
$-65.75
$831.20
$1,093.11
$10.00
$961.52
$91.61
$191.06
$63.78
$836.32
$189.58
$80.00
$1,149.15
$14.00
$50.00
Date Paid
6/21/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
9/25/07
Pae:e 2 of 5
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2007-00924
ISSUED: 09/25/2007
APPLIED: 06/21/2007
EXPIRES: 10/25/2008
VALUE: $ 276,077.00
Value
Date Calculated
$234,737.00
$20,280.00
$21,060.00
$276,077.00
06/21/2007
06/21/2007
06/21/2007
Receipt Number
1200700000000000800
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
1200700000000001231
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Vent Fan
Willamalane Single Family
+ 10% Administrative Fee
+ 12% State Surcharge
+ 5% Technology Fee
Low Voltage - Residential
Minimum/Adjustment Electrical
Total Amount Paid
Structural Review
06/25/2007
Initial Review
06/22/2007
Public Works Review
06/26/2007
Plannin2 Review
06/25/2007
Initial Review
09/19/2007
Structural Review
09/19/2007
$24.00
$2,303.00
$5.00
$6.00
$2.50
$25.00
$25.00
9/25/07
9/25/07
4/25/08
4/25/08
4/25/08
4/25/08
4/25/08
$11,138.11
Plan Reviews I
WE
06/22/2007
APP LLH
06/26/2007
APP BRC
06/28/2007
APP T AJ
09/19/2007
APP LLH
09/24/2007
APP DLM
Pa2e 3 of5
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2007-00924
ISSUED: 09/25/2007
APPLIED: 06/21/2007
EXPIRES: 10/25/2008
VALUE: $ 276,077.00
1200700000000001231
1200700000000001231
2200800000000000525
2200800000000000525
2200800000000000525
2200800000000000525
2200800000000000525
DLM
Returned one set of plans to
contractor for corrections 7/31/07.
Need engineering for: lateral
bracing, load bearing members, load
path of all loads to the foundation,
including truss loads and cantilever
retaining wall design for side wall of
bldg. dIm
Plan review completed after 12:00
noon. Public works will not accept
plans after noon. I will deliver
Monday a.m. (6/25/07)
SDC's calculated and review is
complete.
Stairs in the front need to be at least
10' from the front property line
unless they are less than 2.5' high.
Engineermg submitted as requested
by Don Moore. Applicant returned
his approved plans along with two
sets of engineering. I placed the
information on Don Moores chair.
Additional engineering as required.
One set of marked-up plans was
resubmitted. Copies of marked-up
sheets made and inserted into 2nd
set. 9/24/07dlm.
See documents for Plan review
comments.
CITY OF SPRINGFIELD
Status
Issued
Building/Combination Permit
PERMIT NO: COM2007-00924
ISSUED: 09/25/2007
APPLIED: 06/21/2007
EXPIRES: 10/25/2008
VALUE: $ 276,077.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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.
l..ReouiredJnsnections .
Erosion/Grading Inspection: Prior to ground disturbance and after erosion measures are installed.
Curbcut - Overwidth: After forms are erected but prior to placement of concrete.
Final Gas: When all gas work is complete.
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.
Low Voltage: Prior to cover.
Sidewalk - Curbside: After forms are erected but prior to placement of concrete.
Ufer 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.
Slab: To be made after all inslab building service equipment, conduit piping and other equipment items are in
place but prior to concrete.
Floor Insulation: Prior to decking.
Shear Wall Nailing: Before covering sheathing with finish materials.
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.
Final Building: After all required inspections have been requested and approved and the building is complete.
Underslab Plumbing: Prior to filling the trench and including required testing.
Perimeter Foundation Drains: After gravel and filter cloth is installed but prior to backfill.
Rough Plumbing: Prior to cover and including required testing.
Shower Pan. Prior to covering and including required testing.
Pal!e 4 of 5
CITY OF SPRINGFIELD C
Status
Issued
Building/Combination Permit
PERMIT NO: COM2007-00924
ISSUED: 09/25/2007
APPLIED: 06/21/2007
EXPIRES: 10/25/2008
VALUE: $ 276,077.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
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.
Rough Mechanical: Prior to Cover
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 ofany 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 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 construction.
Owner or Contractors Signature
Date
Pa2e 5 of 5